Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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Identification And The Effective Repair Of The Athletic Hernia
Som Kohanzadeh, MD, Morgan S. Martin, MD, Derek Marrero, MD, Liana M. Lugo, MD, Luis O. Vasconez, MD, David Shokrian, MD.
Univ of Alabama Birmingham, Birmingham, AL, USA.

Purpose: Athletes often suffer from specific injuries, unlike people with more sedentary lifestyles. One such entity is the athletic hernia, otherwise known as a “sports hernia”; presenting with athletic pubalgia; where the groin is affected in such individuals. Chronic inguinal pain in professional or recreational athletes without evidence of a true hernia is the presentation. There is no evidence of inguinal herniation, however, upon examination there is point tenderness at the pubic symphysis, which is accentuated by resisted hip adduction. This is secondary to rupture of the muscular attachment to the pubis (Figure 1). This study describes the identification and diagnosis, followed by operative outcomes using a validated survey in a consecutive series of patients following surgical repair. The repair involves repair and reinforcement of the muscular attachments at the pubic symphysis. This is accomplished through pelvic floor reinforcement with a local muscle flap and mesh (Figures 2-4).
Methods: Over a 12 year period, from 2000 through 2012, the aforementioned sports hernia repair was performed by the senior author (L.O.V) in 51 patients. Demographic data was collected and a Pain questionnaire was used to evaluate postoperative outcomes.
Results: The median age was 22 years. The patients were involved in a variety of sports, including: football (35%), soccer (20%), running (15%), basketball (10%), cycling (8%), baseball (6%), volleyball (4%), and martial arts (2%). 53% of patients were college athletes. There was a 70% survey response rate with only 8% of patients reporting no improvement; 92% with either marked or complete resolution. 78% had resolution of pain within 1 month. The remaining patients were pain free by 12 months postoperatively. 88% had no sports limitations after treatment.
Conclusion: Sports hernia is an often misdiagnosed problem, and thus has limited treatment and even less frequently evaluated outcomes. Imaging studies are often non-diagnostic. However, through physical exam findings, most notably point tenderness at the pubis exacerbating with forced hip adduction. Excellent outcomes were noted with the use of an internal oblique flap overlying a propylene mesh to help repair and reinforce the injury. This method served to relieve the pain and allow return to full activity in the vast majority of patients.




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