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01-02-2017 | How-I-Do-It

Sports hernia repair with adductor tenotomy

Authors: J. N. Harr, F. Brody

Published in: Hernia | Issue 1/2017

Abstract

Purpose

Sports hernias, or athletic pubalgia, is common in athletes, and primarily involves injury to the fascia, muscles, and tendons of the inguinal region near their insertion onto the pubic bone. However, management varies widely, and rectus and adductor tenotomies have not been adequately described. The purpose of this manuscript is to demonstrate a suture repair and a rectus and adductor longus tenotomy technique for sports hernias.

Methods

After magnetic-resonance-imaging confirmation of sports hernias with rectus and adductor tendonitis, 22 patients underwent a suture herniorrhaphy with adductor tenotomy. The procedure is performed through a 4-cm incision, and a fascial release of the rectus abdominis and adductor tenotomy is performed to relieve the opposing vector forces on the pubic bone.

Results

All 22 patients returned to their respective sports and regained their ability to perform at a high level, including professional status. No further surgery was required.

Conclusion

In athletes with MRI confirmation of rectus and adductor longus injuries, tenotomies along with a herniorraphy may improve outcomes. A suture repair to reinforce the inguinal floor prevents mesh-related complications, especially in young athletes.

Cabot J (1966) Osteopatica dinamica del pubis. In: Hanekopf F (ed) Proceedings of the XVI would congress of sports medicine. Deutscher Aertze-Verlag, Hanover, pp 359–364

Gilmore OJ (1991) Gilmore’s groin: ten years experience of groin disruption—a previously unsolved problem in sportsmen. Sports Med Soft Tissue Trauma 1:12–14

Meyers WC, McKechnie A, Philippon MJ, Horner MA, Zoga AC, Devon ON (2008) Experience with “sports hernia” spanning two decades. Ann Surg 248:656–665PubMed

Taylor DC (1991) Abdominal musculature abnormalities as a cause of groin pain in athletes. Am J Sports Med 19:421CrossRefPubMed

Kemp S, Batt ME (1998) The ‘sports hernia’: a common cause of groin pain. Phys Sportsmed 26:36–44CrossRefPubMed

Morelli V, Weaver V (2005) Groin injuries and groin pain in athletes: part 1. Prim Care 32:163–183CrossRefPubMed

Morelli V, Espinoza L (2005) Groin injuries and groin pain in athletes: part 2. Prim Care 32:185–200CrossRefPubMed

Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM, Lovell G, Meyers WC, Muschaweck U, Orchard J, Paajanen H, Philippon M, Reboul G, Robinson P, Schache AG, Schilders E, Serner A, Silvers H, Thorborg K, Tyler T, Verrall G, de Vos RJ, Vuckovic Z, Hölmich P (2015) Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 49:768–774CrossRefPubMedPubMedCentral

Zoga A, Mullens F, Meyers W (2000) The spectrum of MR imaging in athletic pubalgia. Radiol Clin North Am 48:1179–1197CrossRef

10.

Pesquer L, Reboul G, Silvestre A, Poussange N, Meyer P, Dallaudiere B (2015) Imaging of adductor-related groin pain. Diagn Interv Imaging 96:861–869CrossRefPubMed

11.

Khan W, Zoga AC, Meyers WC (2013) Magnetic resonance imaging of athletic pubalgia and the sports hernia: current understanding and practice. Magn Reson Imaging Clin N Am 21:97–110CrossRefPubMed

12.

Nam A, Brody F (2008) Management and therapy for sports hernia. J Am Coll Surg 206:154–164CrossRefPubMed

13.

Steele P, Annear P, Grove JR (2004) Surgery for posterior inguinal wall deficiency in athletes. J Sci Med Port 7:415–421 (discussion 422–423) CrossRef

14.

Brannigan AE, Kerin MJ, McEntee GP (2000) Gilmore’s groin repair in athletes. J Orthop Sports Phys Ther 30:329–332CrossRefPubMed

15.

Stinivasan A, Schuricht A (2002) Long-term follow-up of laparoscopic preperitoneal hernia repair in professional athletes. J Laparoendosc Adv Surg Tech 12:101–106CrossRef

16.

Genitsaris M, Goulimaris I, Sikas N (2004) Laparoscopic repair of groin pain in athletes. Am J Sports Med 32:1238–1242CrossRefPubMed

17.

Polglase AL, Frydman GM, Farmer KC (1991) Inguinal surgery for debilitating chronic groin pain in athletes. Med J Aust 155:674–677PubMed

18.

Rossidis G, Perry A, Abbas H, Motamarry I, Lux T, Farmer K, Moser M, Clugston J, Caban A, Ben-David K (2015) Laparoscopic hernia repair with adductor tenotomy for athletic pubalgia: an established procedure for an obscure entity. Surg Endosc 29:381–386CrossRefPubMed

19.

Santilli OL, Nardelli N, Santilli HA, Tripoloni DE (2016) Sports hernias: experience in a sports medicine center. Hernia 20:77–84CrossRefPubMed

20.

Scholten PM, Massimi S, Hahmen N, Diamond J, Wyss J (2015) Successful treatment of athletic pubalgia in a lacrosse player with ultrasound-guided needle tenotomy and platelet-rich plasma injection: a case report. PM R 7:79–83CrossRefPubMed

21.

St-Onge E, MacIntyre IG, Galea AM (2015) Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report. J Can Chiropr Assoc 59:390–397PubMedPubMedCentral

22.

Moraes VY, Lenza M, Tamaoki MJ, Galoppa F, Belloti JC (2014) Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev 4:CD010071

23.

Paajanen H, Brinck T, Hermunen H, Airo I (2011) Laparoscopic surgery for chronic groin pain in athletes is more effective than nonoperative treatment: a randomized clinical trial with magnetic resonance imaging of 60 patients with sportsman’s hernia (athletic pubalgia). Surgery 150:99–107CrossRefPubMed

Title: Sports hernia repair with adductor tenotomy
Authors: J. N. Harr
F. Brody
Publication date: 01-02-2017
Publisher: Springer Paris
Published in: Hernia / Issue 1/2017
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-016-1520-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Sports hernia repair with adductor tenotomy

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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