Sportsmen’s Groin—Diagnostic Approach and Treatment With the Minimal Repair Technique: A Single-Center Uncontrolled Clinical Review

Abstract

Context:Sportsmen’s groin, also called sports hernia and Gilmore groin, is one of the most frequent sports injuries in athletes and may place an athletic career at risk. It presents with acute or chronic groin pain exacerbated with physical activity. So far, there is little consensus regarding pathogenesis, diagnostic criteria, or treatment. There have been various attempts to explain the cause of the groin pain. The assumption is that a circumscribed weakness in the posterior wall of the inguinal canal, which leads to a localized bulge, induces a compression of the genital branch of the genitofemoral nerve, considered responsible for the symptoms.Methods:The authors developed an innovative open suture repair—the Minimal Repair technique—to fit the needs of professional athletes. With this technique, the circumscribed weakness of the posterior wall of the inguinal canal is repaired by an elastic suture; the compression on the nerve is abolished, and the cause of the pain is removed. In contrast with that of common open suture repairs, the defect of the posterior wall is not enlarged, the suture is nearly tension free, and the patient can return to full training and athletic activity within a shorter time. The outcome of patients undergoing operations with the Minimal Repair technique was compared with that of commonly used surgical procedures.Results:The following advantages of the Minimal Repair technique were found: no insertion of prosthetic mesh, no general anesthesia required, less traumatization, and lower risk of severe complications with equal or even faster convalescence. In 2009, a prospective cohort of 129 patients resumed training in 7 days and experienced complete pain relief in an average of 14 days. Professional athletes (67%) returned to full activity in 14 days (median).Conclusion:The Minimal Repair technique is an effective and safe way to treat sportsmen’s groin.

‘Treatment of the Sportsman's groin’: British Hernia Society's 2014 position statement based on the Manchester Consensus Conference

“…In some cases the genital branch of the genitofemoral nerve is divided particularly if it is found to be under tension 38. This German group reported that 67% of professional athletes returned to full activity at a median of 14 days, although as discussed earlier the presence of ‘tension’ in the vicinity of the nerve appears not to be a measurable phenomenon 39 40. A laparoscopic approach to ID has also been performed by means of a TEP approach 32.…”

Epidemiology of Groin Injuries in Athletes

“…No manifest hernia can be palpated, but the external orifi ce can be enlarged on palpation. Dynamic examination using ultrasonography can be used to visualize the weakness of the abdominal wall during maneuvers that increase intra-abdominal pressure [ 41 ]. Entrapment or damage perhaps as a result of pressure on various regional nerves, most frequently the genital branch of the genitofemoral nerve, can be seen.…”

Differential Diagnostic Difficulties in Athletes with Chronic Groin Pain: A Multidisciplinary Concern

“…Entrapment of the genital branch of the genitofemoral nerve is considered an important part of the cause of pain. Early recovery and early return to sports activities are reported (Muschaweck and Berger 2010).…”