Successful Repair of M. obliquus Internus Abdominis Avulsion at the Iliac Crest—Operative Technique in Professional Soccer Players

OBJECTIVE: Sports related injuries to the anterolateral abdominal wall have been described as side strain injuries or hip pointer. So far, only a few cases of avulsion injuries of the m. obliquus internus abdominis muscle from the iliac crest have been described. All were treated conservatively. The aim of this study is to present the surgical technique. METHODS: This report presents three cases of professional soccer players who were treated surgically with transosseous reattachment to the iliac crest. These male players were 23, 25, and 29 years old. Two of them suffered a direct contusion and one an indirect injury. The diagnosis was suspected based on the patient's history and clinical examination and confirmed by MRI. In each case, the fibrocartilaginous layer of the m. obliquus internus was separated 2 cm from the iliac crest. All three players were operated by aponeurotic m. obliquus internus refixation to the lateral iliac crest (three transosseous drill holes). Return to play was 55, 60, and 122 days postoperatively. Functional limitations, symptoms, sports/recreational activities, and quality of life in terms of occupational, social, emotional, and lifestyle concerns were measured using the iHOT 12 instrument at 11.1 and 9.7 years postoperatively. RESULTS: Six weeks postoperatively, sport‐specific training was started. After 2 to 4 months, all three patients were fully reintegrated into their elite sports and unrestricted sports ability was achieved. Long‐term follow‐up was performed using the German version of the iHOT‐12 questionnaire and 92.7% and 99.9% were calculated for the two German speaking soccer players. CONCLUSIONS: Our cases demonstrate that transosseous suture reattachment was a successful procedure that allowed a safe and predictable return to sport. Full performance and excellent, long lasting treatment results were achieved.