Intra-muscular botulinum toxin A in chronic athletic pubalgia: a retrospective observational study

Background: Chronic athletic pubalgia is a frequent sport condition in which the effectiveness of medical treatment has not been proven. Intra-muscular injection of botulinum toxin A may have positive effects on pain in some chronic tendinitis. We aimed to describe the short-term evolution of pain, activity limitations and quality of life, after an injection of the adductor longus with botulinum toxin A, in individuals with chronic athletic pubalgia, for whom medical and/or surgical treatments have failed. Method: We conducted a retrospective observational single-centered study. We included consecutive individuals with chronic athletic pubalgia for whom medical and/or surgical treatments have failed and who were treated with an intra-muscular injection of botulinum toxin A injection (100 International Unit (IU) of botulinum toxin A in the adductor longus ) under ultrasound guidance. Participants were assessed 50 days after injection for pain using a numerical rating scale (NRS) (0, no pain, and 100, maximal pain) and for activity limitations and quality of life using the Copenhagen Hip and Groin Outcome Score (HAGOS) (0, worse outcome, and 100, most favorable outcome). Participants were also asked to self-report adverse events. Results: : We included 20 participants. Mean age was 34.3 (11.7) years and mean symptom duration was 48.9 (61.6) months. Mean pain decreased from 55.3 (SD [22.4] before injection to 38.3 [21.7], 50 days after injection (p=0.027). Mean HAGOS total score increased from 47.0 (12.1) to 58.6 (10.7). No adverse events were self-reported in participants included in analyses. Serious adverse events were reported in 3 individuals who were not included in analyses because of missing data. Conclusion: We observed a numerical decrease in pain intensity in individuals with chronic athletic pubalgia 50 days after intra-muscular botulinum toxin A injection in the adductor longus . Trial registration number: Clinical Trial: NCT05430893 (24/06/2022)