The Lloyd Release Procedure:
A New Concept – "Release the ligament - release the pain"
The Release Procedure© is a new and innovative operation based on the fact that most of the pain of a groin strain comes from recurrent strain injury affecting the inguinal ligament, lacunar ligament and pectineal ligament, or an acute strain of the inguinal ligament at the attachment to the pubic bone.
Although there may be other factors contributing to the pain, such as a tear in the conjoint tendon or a strain of the rectus muscle, the primary problem in the majority of athletes is due to pathology in and around the inguinal ligament attachment. The strains cause disruption and tearing within the attachment, resulting in holes appearing in the lacunar ligament. There could well be an enthesopathy of the insertion onto the pubic bone, although this is debateable. These photographs show, for the very first time, that there are multiple tears in the inguinal ligament causing the symptoms.
The pathology of a groin strain is very similar to that which occurs in tennis elbow. A strain in the groin causes a painful inflammatory reaction that does not settle spontaneously because the ligament is always under tension and any movement of the abdominal muscles or leg muscles exacerbates the inflammation and the pain continues. Many athletes can even feel the tension in the ligament by simply pressing on the ligament near the pubic bone. Coughing and straining can precipitate the pain but sneezing, in particular, commonly reproduces the exact severe symptoms. By releasing the ligament from the bone there is no more pulling, no more tension, the inflammation is allowed to settle and the pain improves.
The Release Procedure© is done via keyhole surgery performed under a full general anaesthetic. The whole procedure typically takes less than one hour to perform, although if a player has had previous surgery it could take longer.
Three tiny incisions are made in the abdomen at the level of the umbilicus and a telescope (laparoscope) is inserted to allow the groin area to be explored. The inguinal ligament and lacunar ligament are assessed for tears and inflammation and divided, and the pectineal ligament and fascia are also carefully assessed and released if they are under tension. Once all the ligaments are freed the area is covered with a 12cm x 15cm synthetic mesh, as is done during a routine laparoscopic hernia repair. The three tiny wounds are sutured with hidden sutures that cannot be seen, and then infiltrated with local anaesthetic.
After the operation athletes are encouraged to mobilise quite quickly by performing stretching exercises within 24 hours. Patients can bathe and shower the next day, but cannot drive (legally) for a full 24 hours because of the anaesthetic. There is no restriction on activity after the release procedure and athletes are encouraged to return to light training within days and try and resume normal training within a week. The goal should be that players return to their full sporting activities within two weeks.