Operative Repair of Sports Hernia

Benjamin Biteman, MD, Fredrick Brody, MD, FACS. The George Washington University

Introduction: Sports hernia is a misnomer. The term Sports hernias, more appropriately called athletic pubalgia, is not the typical hernia involving a defect in the strength layer of the abdominal wall. Sports hernias are related to injury and/or inflammation of the tendonous attachments to the pubic tubercle often involving the abdominal and pelvic musculature outside the ball-and-socket hip joint and on both sides of the pubic symphysis. Patients are often athletes and present with groin pain without physical or radiographic signs of an inguinal hernia. Presence of inflammation or injury to the pelvic muscles is evident on MRI. First line treatment is nonoperative but some patients with competitive obligations request operative intervention.

Methods: We present a video of an open operative approach to release the rectus abdominus and adductor tendons with aim to lateralize vector force away from the pubic tubercle. This technique has been demonstrated on 21 patients all with favorable outcomes.

Results: We present 21 patients, 18 of which are collegiate or professional athletes who underwent operative release and repair. Preoperative MRI was used to confirm clinical suspicion of sports hernia.  No recurrences have been identified. Athletes have returned to full competitive status and some receiving All conference and All state accolades.

Conclusion: Rectus and adductor tendon release is an operative option for competitive athletes and has shown good success in a small patient population. Better objective follow up is needed.

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