Thank you, Matt, and thank you for the committee for inviting me. I'm honored to be here with this group of surgeons. And full disclosure, I don't have any video testimonial, but I'm happy to present. So acute groin injuries are pretty rare. And what we've shown is that Dr. Bolger injuries are rare athletic injuries. When they occur, they occur and lead to disabling groin pain, as we showed in these recent systematic reviews. We did a bioanatomical study and partnered with Ernest Schilders to understand a little bit more about these adductor or bulging injuries and where they occur. And what we found was that there is correlation with the adductor of where it asserts onto with the pyramidalis to the pubic ligament. And this better understands about where, if we can manage these patients surgically or non-operatively. And we found that the rectus abdominis has its own assertion on the pubis. And when we create an avulsion injury, we see that the pyramidalis and the complex is disrupted. This may explain why some of these athletes have disabling groin pain. And this is what you should be looking at when you get MRIs on these athletes. So this is just a case example of a 29-year-old hockey player, mid-season, got a groin injury. And the medical team staff was great about charting his injury. At the end of May, he was basically skating on one leg. And what he had was a complete avulsion of the adductor with the pyramidalis. And he was indicated for a surgical repair. And here, we're doing the inguinal approach. And you can see that beyond the inguinal ligament, you see fluid coming out. He's got a full thickness rupture showing his pubis. And we got a general surgeon to give us assistance on this because you need a spermatic cord. And here, we developed a technique where we're replacing suture anchors to restore and replace this proximal to the pubis. And then the fibrocortis, reattaching it with suture anchors. And here, we did a seven-suture anchor repair. And post-op, here he is four months after returning back to play. And at 21 months, you can see from pre-op to post-op, we restore his surgical anatomy. Well, I came up with this technique back in 2020, 2012, on this professional dancer who had this avulsion injury that couldn't go back to dance. And then, as time developed, we actually purported on a two-year outcome on this technique. And you can see that these patients were pretty disabling. But on our purported outcomes, they actually returned to play at an average of four months. We took it one step further and validated optimal suture anchor replacement, not only for the number four anchors, but also in placement. So first, I just want to thank my colleagues because without them, I wouldn't be able to get to the point where we are. But the innovation of the technique, the value of this is really how we manage these patients and best help, particularly professional team athletes who take care of players, validation based not only on biomechanics and anatomy, but we're looking at longer-term outcomes on these patients. And hopefully for replication because that's where the adoption is for the surgeons and for the team physicians. Thank you. Great presentation. Thank you. I think it's wonderful that orthopedics can own more and more of the hip and sports hernia world. Questions? Yes, sir. Tell us about over-constraint, re-tears, re-injury, anatomic repair, and why orthopedics is better at this than our colleagues in general surgery. That's a great question. I don't think necessarily that we're better, but when it comes to actually repair of these structures, we do have equipment to use, familiarities with options of either suture anchor repairs. Sometimes they get bony avulsions, particularly younger patients. So I think it's better to manage to handle that orthopedically. It's part of our training from day one. Just my bias. All right. Well, thank you very much. That concludes the presentations. Judges are going to meet here for two minutes.

acute groin injuries

adductor or rectus abdominis avulsion injuries

surgical repair using suture anchors

return to play

orthopedics