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The Painful Symphysis Syndrome in Athletes and Treatment Possibilities

29 Jan, 13 | by Karim Khan

Reproduced with permission from the Aspetar Sports Medicine Journal. December 2012. Issue 3: 254-257.


 Reflection on the topic after 20 years of personal experience

Written by Branislav Nesovic, Serbia. Translated by Zarko Vuckovic, Qatar


Sports-related groin pain has been in the spotlight for the last 30 years, with an increasing number of high level athletes, especially football players, being sidelined for significant periods of time.

This year is the 10th anniversary of the death of Dr Branko Nesovic (1930-2002), an orthopaedic surgeon from Belgrade, Serbia who, in 1967 came up with a surgical solution to this problem by reinforcing the inguinal wall with a modification of the Bassini hernia repair technique. Years later, after withstanding the test of time, his technique opened the door for other different surgical modifications in an attempt to decrease postoperative recovery time.

It is worth mentioning that Nesovic was a football player himself before becoming a doctor, playing for Red Star Belgrade. He worked in the Banjica Orthopaedic Hospital in Belgrade but remained connected to football throughout his career as the Red Star team physician.

The following is one of the rare papers on his understanding of sports related groin pain pathogenesis and a description of his surgical technique, originally published in Serbian for a sports magazine.

We provide this translation in English to inform our English-speaking doctors of this interesting and important doctor who is not necessarily recognised in the literature but who made valuable contributions to the specialty as a pioneer in athletes’ groin pain surgery.


Photo courtesy of Qatar Stars League

Photo courtesy of Qatar Stars League

“The symphysis syndrome, groin pain, pubalgia, or any one of many polypragmatic terms for describing this pathology, has had such an increase in frequency in the last two decades that we can take the liberty to consider it a serious epidemic in sports traumatology. There are a significant number of talented athletes, who have had difficulties in achieving their athletic potential due to this painful syndrome, or who have had to stop their careers early. This painful entity affects athletes participating in different sports, particularly football players. This phenomenon has attracted huge interest between many sports medicine doctors, coaches and athletes themselves.

Dysfunction of the femoro-inguinal region with resulting groin pain was first noticed in sport 50 years ago (Spinelli 1932), but became more frequent in the last 30 years. Painful groin syndrome was first recognised in football players and was later also found in other athletes. This condition was therefore named ‘footballer’s groin’. The incidence increased particularly after the introduction of intensive daily training sessions and the playing of a huge number of matches during a season without the possibility for full recovery after sport activity.

Groin pain syndrome has, over time, become more embarrassing for treating physicians who face the difficult task of scientifically explaining its aetiology and searching for the most effective method that could help their athletes’ to full recovery. Multiple treatment modalities for this entity were proposed.

In the past, a variety of conservative and surgical methods requiring several months of treatment unfortunately did not fulfil expectations. There was high percentage of recurrence after return to play, which was very unpleasant for the athletes and also treating physicians. Facing the painful symphysis, most sports physicians found themselves in an undesirable situation due to the inability to appropriately treat this pathology with familiar treatment options. Affected athletes considered ending their sports career. All of that led to an inevitable conflict between athlete, physician, coaches, managers, staff, fans and media.

I would like to share my significant experience in the surgical treatment of painful symphysis syndrome in football players over the past 20 years. Accepting current views on the aetiopathogenesis of this condition in athletes and the variety of modalities for treating symphysis syndrome (according to subjective belief and clinical findings) and using a biomechanical approach, in 1967 I tried for the first time, to resolve this painful phenomenon with surgery utilising a modified Bassini technique.

I presented our first results on 14 football players surgically treated by our operative technique with very good clinical outcome on the 18th World Congress of Sports Medicine in Oxford 1970. more…

Paul Hodges and Irene Davis keynotes for 3rd International Patellofemoral Pain Research Retreat & Clinical Symposium. Save the date September 18-21 2013, Vancouver, Canada

23 Dec, 12 | by Karim Khan


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