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

34. Patient with Groin Pain After an Athletic Event
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A number of prospective non-randomized series have evaluated the
efficacy of laparoscopic TAPP and TEP repairs for athletic pubalgia.
Most have included small numbers of patients ( n = 14–131) and have
utilized mesh reinforcement of the myopectineal orifice. Over an average
follow-up of 12 months (range 3–48 months), 87–100 % of athletes
were able to return to full activity within 3 months of surgery, with many
patients resuming full competitive athletics within 3–4 weeks [ 4 , 5 , 16 , 17 ].
One potential advantage of the laparoscopic repair is the ability to treat
patients with bilateral injuries simultaneously through a three-port
approach.
In our patient, preoperative imaging demonstrated evidence of bilateral
rectus abdominis and adductor longus avulsion injuries, while clinical
symptoms and examination findings were localized primarily to the
inguinal canals and pubic tubercle, consistent with musculotendinous
disruptions of the posterior inguinal wall, transversalis fascia, and the
rectus insertions onto the pubis. In our experience, these patients are best
served by initial reinforcement of the groin with mesh, as the large
majority will experience symptom resolution without any further intervention.
For those patients in whom adductor symptoms predominate,
adductor release can be performed either as an isolated procedure or can
be combined with TAPP, TEP, or open repair using mesh. Since many
surgical options exist, patient selection is critical and the approach must
be tailored to the specific diagnosis, based upon preoperative clinical
and radiographic localization of the anatomic site of injury. As shown in
Table 34.2 , there is no single procedure that can be universally applied
to all patients with athletic pubalgia; the specific intervention must be
applied to the pathology being treated. Results have been excellent in
general, with the large majority of athletes returning to full sporting
activity following surgical intervention [ 4 , 12 – 17 ]. Due to small numbers
of patients being treated in most series, however, these techniques
cannot be compared from a statistical standpoint, nor has there been a
controlled trial to determine whether one surgical technique is superior.
Conclusion
Athletic pubalgia (frequently referred to as “sports hernia”) is a common
entity among athletes, though the specific anatomic and physiologic
mechanisms for chronic groin pain remain poorly understood. As
a result, no one surgical solution can be applied to all patients. In athletes