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142 Thursday 1 November Posters / Journal of Sc

round a synthesis of previous literature has been proposed tossist in the diagnosis of exercise related pubic pain (ERPP). Theight sub-groups in this proposed clinical model are abdominalnthesopathy, abdominal tendinopathy, adductor enthesopathy,dductor tendinopathy, pre-pubic complex tears, pubic bone mar-ow oedema, pubic symphysis irritation and pubic instability,owever validation of the clinical model is required. The lack ofgold standard in this region makes validating these clinical sub-roups a challenging process. The aim of this study was to explore,ia focus groups, current opinions on the presentation of ERPP. Aarticular focus was to explore opinion on the existence of theseroposed sub-groups.

Method: Using the pre-developed clinical model as a foun-ation, exploratory focus groups that included sports physi-ians, orthopaedic surgeons, radiologists, physiotherapists andnatomists recognised as experts in hip and groin pain were con-ucted. The four focus groups included between 4 to 8 participantsho were asked to comment on the following questions:

What pathologies exist that have the potential to present as ERPParound the pubic symphysis?What is a clear, recognisable description of each pathology orsub-group?What do you consider as the onset of ERPP?What do you consider as signs of full resolution of symptoms?What other structures and pathologies may present as exerciserelated groin pain?

Following completion of focus groups audio recordings wereranscribed and thematic analysis completed.

Results: Focus groups demonstrated varied support for thexistence of the proposed sub-groups. Several other structuresere identified as potential sources of groin pain.

Discussion: These results may provide an insight into the fea-ibility of the proposed sub-groups of ERPP and other diagnosticonsiderations. For sub-groups recognised as feasible during theseocus groups further research is required to identify the clinical andadiological features of these groups. Methodology that attemptso reach consensus between multiple clinicians will increase confi-ence in the existence of these sub-groups and provide preliminaryalidation of this clinical model.

ttp://dx.doi.org/10.1016/j.jsams.2012.11.342

40

evision ACL reconstruction after use of the LARS ligament: Aase series

. Roe ∗, H. Bourke, C. Glezos, L. Salmon, A. Waller, L. Pinczewski

North Sydney Orthopaedic and Sports Medicine Centre

Introduction: The Ligament Augmentation Reconstruction Sys-em (LARS. Surgical Implants and Devices, Arc-sur-Tille, France) is aynthetic non-absorbable augmentation device made of polyethe-yne terephtalate (PET). It has rapidly gained popularity in Australia

ith 982 used in 2009 and 1050 in 8 months in 2010 according tohe manufacturers website. Whilst autograft use in Anterior cru-iate ligament (ACL) reconstruction has demonstrated excellentlinical results, little has been published to support the use of artifi-

ial ligaments. Poor patient outcomes associated with graft failure,unnel osteolysis, foreign body synovitis and premature arthritisre among the reasons that artificial ligaments were abandonedver two decades ago.

nd Medicine in Sport 15 (2012) S127–S187

Method and results: We report a case series of 7 patients whoattended to our clinic for revision of failed LARS ACL reconstruction.In 5 patients single stage revision was possible but in 2 patients a 2staged procedure was required. There were 4 males and 3 females,mean age 27 years (range 20–37). One 33 year old male (casenumber 2) demonstrated significant synovitis necessitating a com-plete synovectomy. Histopathological analysis revealed findingsthat were consistent with a haemosiderotic synovitis in a setting ofchronic tissue reaction to foreign material (LARS ligament).

Conclusion: Given the demonstrated foreign body synoviticreaction to the LARS ligament and initiation of an iatrogenic degen-erative process, we assert the LARS device, like its artificial graftpredecessors, should be used with great caution, if at all, for treat-ment of ruptures of the ACL, particularly in young healthy patients.

http://dx.doi.org/10.1016/j.jsams.2012.11.343

341

Investigating cortical changes associated with patellartendinopathy

E. Scase 1, J. Cook 1,∗, D. Kidgell 2, S. Jaberzadeh 1, A. Pearce 2

1 Monash University2 Deakin University

Introduction: Tendinopathy, the clinical syndrome of pain anddysfunction in a tendon is debilitating, recalcitrant to treatmentand therefore often termed a chronic condition. Importantly, it isnot known how the central nervous system modulates or interpretstendon pain and whether it is similar to other chronic pain con-ditions. This study aims to investigate whether there are corticalexcitability differences between people with and without patel-lar tendinopathy. Cortical excitability and inhibition are importantdeterminants for muscle function and, as such, any differencesbetween healthy and tendinopathic participants may provide datafor the altered muscle function associated with tendinopathy andimprove future rehabilitation directions. Cortical differences inother chronic musculoskeletal pain conditions have provided clin-ically useful direction of treatment.

Methods: Male and female volleyball players aged over 18 yearswith and without patellar tendinopathy, matched for age, genderand activity level will be invited to participate in the study. Objec-tive measures of single leg decline squat pain, tendon ultrasoundand maximal voluntary leg extension torque will be recorded. Sin-gle and paired pulse transcranial magnetic stimulation (TMS) willbe applied over the motor area projecting to the quadriceps musclegroup to obtain measures of corticospinal excitability and intracor-tical inhibition. Stimulus-response curves will be obtained and theslope and peak values will be used to establish the strength of pro-jection. Results of tendinopathic and healthy individuals will becompared. Pain severity and length of time of symptoms will becorrelated with TMS measures to identify whether a relationshipexists.

Hypothesised Results: It is hypothesised that individuals withpatellar tendinopathy will show differences compared with nor-mals of reduced cortical excitability and that changes will be morepronounced with increasing chronicity of symptoms.

Discussion: The incidence of tendinopathy is increased withaging and activity and may cause a person to become sedentary dueto load related pain. Improving our understanding of this conditionis vital. This will be the first study to examine the cortical changes

in people with tendon pain. Differences identified will be corre-lated to clinically useful measures of severity of pain and lengthof time of symptoms to determine the effect of chronicity. This