Surgical options in the treatmentof sports hernia

Abstract

Groin injuries in athletes are seen with increasing frequency. The insidious onset of groin pain in professional athletes may be caused by a range of musculoskeletal conditions and injuries. The diagnosis of occult or hernia must be considered in athletes who do not respond to conservative treatment modalities directed at these entities. A review of diagnostic workup and presenting symptomatology is given. In addition, a retrospective literature review of the surgical treatment of sports hernias is presented, including the lead author's personal experience with laparoscopic hernia repair. Comparison is made between operative findings, surgical techniques, and long-term results. Although length of recovery and return to activity varied from series to series, laparoscopic hernia repair provided the quickest return to full, unrestricted athletic activity in 4 weeks or less. Laparoscopic preperitoneal hernia repair should be considered as a treatment modality in athletes presenting with chronic groin pain. Groin injuries in athletes are seen with increasing frequency. Estimates suggest that 5% of all sports injuries occur in the groin. It has been postulated that such injuries are more common from sports that require repetitive fast twisting and turning movements (eg, soccer and hockey). I Injuries to the adductor longus, iliopsoas, and rectus femoris muscles are the most common causes of groin pain in athletes. Other causes of groin pain include ilioinguinal neuralgia, osteitis pubis, genitourinary sources (prostatitis, epididymitis, urethritis, hydrocele), bursitis, arthritis of the hip, and sports hernias. Sports hernias can best be described as incompetence of the abdominal wall musculature in the absence of a clinically detectable hernia bulge. The prevalence of such hernias found at surgical exploration in athletes with chronic groin pain is reported to be as high as 80%. 2,3 However, since up to 50% of these athletes have an occult hernia in the contralateral groin, the presence of a hernia does not necessarily correlate with symptoms. 4