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Hernia

, Volume 18, Issue 6, pp 815–823 | Cite as

Sports hernia or groin disruption injury? Chronic athletic groin pain: a retrospective study of 100 patients with long-term follow-up

  • J. F. W. GarveyEmail author
  • H. Hazard
Original Article

Abstract

Introduction and objectives

Chronic groin pain (athletic pubalgia) is a common problem in sports such as football, hockey, cricket, baseball and athletics. Multiple co-existing pathologies are often present which commonly include posterior inguinal canal wall deficiency, conjoint tendinopathy, adductor tendinopathy, osteitis pubis and peripheral nerve entrapment. The mechanism of injury remains unclear but sports that involve either pivoting on a single leg (e.g. kicking) or a sudden change in direction at speed are most often associated with athletic pubalgia. These manoeuvres place large forces across the bony pelvis and its soft tissue supports, accounting for the usual clinical presentation of multiple symptomatic abnormalities forming one pattern of injury.

Results

The diagnoses encountered in this series of 100 patients included rectus abdominis muscle atrophy/asymmetry (22), conjoint tendinopathy (16), sports (occult, incipient) hernia (16), groin disruption injury (16), classical hernia (11) traumatic osteitis pubis (5), and avulsion fracture of the pubic bone (4). Surgical management was generally undertaken only after failed conservative therapy of 3–6 months, but some professionals who have physiotherapy during the football season went directly to surgery at the end of the football season. A variety of operations were performed including groin reconstruction (15), open hernia repair with or without mesh (11), sports hernia repair (Gilmore) (7) laparoscopic repair (3), conjoint tendon repair (3) and adductor tenotomy (3). Sixty-six patients were available for follow at an average of 13 years after initial consultation and the combined success rate for both conservative treatment and surgery was 94 %.

Conclusion

The authors believe that athletic pubalgia or sports hernia should be considered as a ‘groin disruption injury’, the result of functional instability of the pelvis. The surgical approach is aimed at strengthening the anterior pelvic soft tissues that support and stabilise the symphysis pubis.

Keywords

Sports hernia Conjoint tendinopathy Adductor tendinopathy Osteitis pubis Athletic pubalgia Groin disruption injury 

Notes

Acknowledgement

Dr Michael T.W. Houang, Castlereagh Imaging Edgecliff—for performing CT scans Dr John W Read, Castlereagh Imaging St Leonards—for performing many of the ultrasounds and for providing the sonographs used in this article and review of the diagnostic imaging and the manuscript. Dr James Caristo—for Surgical Assistance. Ms Shauna McLean (B Soc Work)—for performing the long term follow-up Mrs Tracey Garvey (B Appl Sci)—for meticulous data collection and analysis.

Conflict of interest

None.

Supplementary material

10029_2013_1161_MOESM1_ESM.pdf (19 kb)
Supplementary material 1 (PDF 19 kb)

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Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Groin Pain ClinicSydneyAustralia
  2. 2.SydneyAustralia

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