Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

27. The Role of Bioactive Prosthetic Material…
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the adductor muscle using absorbable sutures (3–0 Vicryl). Again, I
apply fibrin sealant to the underside of the mesh that is in contact with
the tendon.
I have the player and the athletic trainer begin a structured rehabilitation
protocol on day 8 after surgery and continue for 3–4 weeks. The
results have been excellent, and most of these athletes have returned to
full participation of sports within 4–5 weeks.
Lastly, when discussing “biologic” treatments for sports hernias, it
is important to mention platelet-rich plasma (PRP) . This product has
been popularized in the orthopedic literature for treatment of tendinopathies
and other orthopedic conditions. PRP is derived from the
patient’s own blood and then injected into the site of pain. It is a concentrated
source of growth factors and cellular signals that play a role
in the biology of healing—not too dissimilar to description of the
purpose of biologic mesh. Basic science research infers that PRP may
improve tissue healing. There are few clinical studies in humans that
confirm the effectiveness of PRP. The controversy is further questioned
when one considers that placing a needle into a bone or tendon
can stimulate bleeding containing platelets and a healing response
occurs. That said, the value of PRP is being proven in certain disease
states, demonstrating its role in improving healing, especially for tendinopathies
and orthopedic injuries [ 27 ] .
Conclusions
While there are now several different BPMs available on the market,
they differ in their mammalian tissue source, their tissue of origin, and
their methods of processing. The existence of these various materials
suggests that the ideal mesh is not yet available. Also, the lack of clinical
evidence on most of these products prevents surgeons from making
evidence- based choices for their use.
From what has been learned over several years of research and published
clinical evidence, BPMs can be used clinically in many different
surgical procedures with low rates of complications and few reports of
mesh rejection. Certain types of hernias seem to be better adapted to the
use of BPMs; thus, the pathophysiology of the hernia should be considered
when using these materials. BPMs have been successfully implanted
in young, healthy individuals who have developed a hernia or weakness
due to physical activity of extreme muscular training. As long as the
patient does not have a history of recurrent hernias, a large direct ingui-