My Approach to Athletic Pubalgia

Abstract

Groin injuries are a common problem in sports and can be a diagnostic and management challenge for trainers and physicians. These injuries can also result in a significant loss of playing time for the athlete. Proper management of athletic groin injuries requires a thorough understanding of the regional anatomy of the groin, differential diagnosis, and clinical presentation of the various injuries. Athletic pubalgia or sports hernia represents a subset of athletic groin injuries that fails to resolve with conservative management. The diagnosis is made by a combination of history, physical exam, and imaging, usually with MRI. Surgical treatment of sports hernia pubalgia is indicated for symptoms that limit athlete performance, failure of a minimum period of 6–8 weeks of conservative management, and exclusion of other diagnoses. A variety of surgical approaches have been used to treat this condition, which include open primary tissue repairs, open tension-free mesh repairs (favored by the author), and laparoscopic mesh repair. Surgical treatment has been reported to result in a successful return to athletic activity in approximately 90 % of athletes. A dedicated postoperative rehabilitation program can be beneficial in guiding trainers and therapists postoperatively and in facilitating return to sport. A multidisciplinary team approach that includes the sports orthopedist, athletic trainer, and general surgeon knowledgeable about athletic groin injuries and sports hernia pubalgia is key to a successful outcome.