Sports Hernia

Minnich, John M.; Hanks, John B.; Muschaweck, Ulrike; Brunt, L. Michael; Diduch, David R.

doi:10.1177/0363546511402807

Cited by 80 publications

(35 citation statements)

References 55 publications

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“…20 The injury mechanism may involve hyperabduction of the thigh with associated trunk hyperextension, which produces shear forces to the pubic symphysis and surrounding musculature. 13,25 The injury may be acute trauma or chronic overuse microtrauma.…”

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confidence: 99%

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Performance and Return to Sport After Sports Hernia Surgery in NFL Players

Jack

Evans

Echo

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Recognition, diagnosis, and treatment of athletic pubalgia (AP), also known as sports hernia, once underrecognized and undertreated in professional football, are becoming more common. Surgery as the final treatment for sports hernia when nonsurgical treatment fails remains controversial. Given the money involved and popularity of the National Football League (NFL), it is important to understand surgical outcomes in this patient population.Hypothesis:After AP surgery, players would: (1) return to sport (RTS) at a greater than 90% rate, (2) play fewer games for fewer years than matched controls, (3) have no difference in performance compared with before AP surgery, and (4) have no difference in performance versus matched controls.Study Design:Cohort study; Level of evidence, 3.Methods:Internet-based injury reports identified players who underwent AP surgery from January 1996 to August 2015. Demographic and performance data were collected for each player. A 1:1 matched control group and an index year analog were identified. Control and case performance scores were calculated using a standardized scoring system. Groups were compared using paired Student t tests.Results:Fifty-six NFL players (57 AP surgeries) were analyzed (mean age, 28.2 ± 3.1 years; mean years in NFL at surgery, 5.4 ± 3.2). Fifty-three players were able to RTS. Controls were in the NFL longer (P < .05) than players who underwent AP surgery (3.8 ± 2.4 vs 3.2 ± 2.1 years). Controls played more games per season (P < .05) than post-AP players (14.0 ± 2.3 vs 12.0 ± 3.4 games per season). There was no significant (P > .05) difference in pre- versus post-AP surgery performance scores and no significant (P > .05) difference in postoperative performance scores versus controls post-index.Conclusion:There was a high RTS rate after AP surgery without a significant difference in postoperative performance, though career length and games per season after AP surgery were significantly less than that of matched controls.

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confidence: 99%

“…25 Failure of nonsurgical treatment may be an indication for surgery. Electing surgery as the final treatment for sports hernia remains controversial.…”

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confidence: 99%

Performance and Return to Sport After Sports Hernia Surgery in NFL Players

Jack

Evans

Echo

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Reports after sports hernia/athletic pubalgia surgeries have demonstrated a predictable return to athletics. 3,6,8,12-14,16,19-21,24 The variety of procedures and lack of outcomes measures in these studies, however, make it difficult to determine if one surgical approach is clearly superior. There is also increasing awareness of an association between range of motion–limiting hip disorders (femoroacetabular impingement [FAI]) and sports hernia/athletic pubalgia in a subset of athletes.…”

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confidence: 99%

Sports Hernia/Athletic Pubalgia

Larson

2014

Sports Health: A Multidisciplinary Approach

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Context:Sports hernia/athletic pubalgia has received increasing attention as a source of disability and time lost from athletics. Studies are limited, however, lacking consistent objective criteria for making the diagnosis and assessing outcomes.Evidence Acquisition:PubMed database through January 2013 and hand searches of the reference lists of pertinent articles.Study Design:Review article.Level of Evidence:Level 5.Results:Nonsurgical outcomes have not been well reported. Various surgical approaches have return-to–athletic activity rates of >80% regardless of the approach. The variety of procedures and lack of outcomes measures in these studies make it difficult to compare one surgical approach to another. There is increasing evidence that there is an association between range of motion–limiting hip disorders (femoroacetabular impingement) and sports hernia/athletic pubalgia in a subset of athletes. This has added increased complexity to the decision-making process regarding treatment.Conclusion:An association between femoroacetabular impingement and athletic pubalgia has been recognized, with better outcomes reported when both are managed concurrently or in a staged manner.

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“…1,13,17,22,24 The incidence of athletic pubalgia in male soccer players ranges from 10% to 18%. 18 The cause of athletic pubalgia is not well understood but is often linked to overuse injuries. 1,10 Muscle imbalance between the hip adductor and rectus abdominus muscles leading to increased shear stress at the pubic symphysis can cause chronic groin pain and athletic pubalgia.…”

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confidence: 99%

Radiographic Evidence of Femoroacetabular Impingement in Athletes With Athletic Pubalgia

Economopoulos

Milewski

Hanks

et al. 2013

Sports Health: A Multidisciplinary Approach

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Background:Two of the most common causes of groin pain in athletes are femoroacetabular impingement (FAI) and athletic pubalgia. An association between the 2 is apparent, but the prevalence of radiographic signs of FAI in patients undergoing athletic pubalgia surgery remains unknown. The purpose of this study was to determine the prevalence of radiologic signs of FAI in patients with athletic pubalgia.Hypothesis:We hypothesized that patients with athletic pubalgia would have a high prevalence of underlying FAI.Study Design:Case series.Level of Evidence:Level 4.Methods:A retrospective review of all patients evaluated at our institution with athletic pubalgia who underwent surgical treatment (ie, for sports hernia) from 1999 to 2011 was performed. The radiographs of patients with athletic pubalgia were reviewed for radiographic signs of FAI. Alpha angles were measured using frog-leg lateral radiographs. Pincer lesions were identified by measuring the lateral center-edge angle and identifying the presence of a “crossover” sign on anteroposterior radiographs. Phone follow-up was performed 2 years or more after the initial sports hernia surgery to evaluate recurrent symptoms.Results:Forty-three patients underwent 56 athletic pubalgia surgeries. Radiographic evidence of FAI was identified in at least 1 hip in 37 of 43 patients (86%). Cam lesions were identified in 83.7% of the population; the alpha angle averaged 66.7° ± 17.9° for all hips. Pincer lesions were present in 28% of the hips. Eight patients had recurrent groin pain, 3 patients had revision athletic pubalgia surgery, and 1 had hip arthroscopy.Conclusion:The study demonstrates a high prevalence of radiographic FAI in patients with athletic pubalgia.Clinical Relevance:Underlying FAI may be a cause of continued groin pain after athletic pubalgia surgery. Patients with athletic pubalgia should be evaluated closely for FAI.

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Sports Hernia

Cited by 80 publications

References 55 publications

Performance and Return to Sport After Sports Hernia Surgery in NFL Players

Performance and Return to Sport After Sports Hernia Surgery in NFL Players

Sports Hernia/Athletic Pubalgia

Radiographic Evidence of Femoroacetabular Impingement in Athletes With Athletic Pubalgia

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