Sports Hernia with Adductor Tendonitis
Sports hernias, or athletic pubalgia, encompass injuries to the tendons and muscles of the rectus abdominis and adductor longus at their respective insertions along the pubic bone. Although not a true hernia, this term was adopted to describe chronic groin pain in athletes. These injuries are actually micro-tears in the tendinous insertions and aponeurotic sheaths of the rectus abdominis or adductor longus muscles. Magnetic resonance imaging (MRI) is the optimal test to diagnose sports hernias. Initially, a trial of nonoperative management is recommended, and includes several weeks of physical therapy while refraining from strenuous activity. If pain persists, surgical intervention is offered and has a high success rate. Commonly, both the rectus and adductor insertions are involved; therefore, both injuries should be treated simultaneously. An overlying tenotomy (fasciotomy) of both aponeurotic sheaths and tendons usually resolves the underlying edema and inflammation. This chapter reviews the clinical presentation and diagnosis of sports hernias with adductor tendonitis, and illustrates the surgical management.
KeywordsSports hernia Athletic pubalgia Adductor tendonitis Rectus abdominis Groin pain
Adductor Tenotomy: With the spermatic cord retracted medially and the subcutaneous tissues retracted inferiorly with a Deaver retractor, the adductor longus tendon is divided with electrocautery 2 cm distal to its insertion on the pubic bone. (MP4 33121 kb)
Fascial Release: The right rectus fascia is incised, and retracted medially creating the fascial flap to be sutured to the ileopubic tract. (MP4 19241 kb)
Suture Repair: A Richardson retractor exposes the right rectus muscle medially, and two hemostat clamps retract the lateral portion of the external oblique laterally. A 2-0 polypropylene suture is used to sew the released right rectus fascia to the iliopubic tract. This is completed in two layers. (MP4 51725 kb)
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