Topic: C. Clinical GI
Experience with "Sports Hernia" Spanning Two Decades
William C Meyers1, Alex McKechnie2, Marc J Philippon3, Marcia A Horner1, Octavia N Devon1, Adam C Zoga4
1Drexel University, Philadelphia, PA;2Los Angeles Lakers, Los Angeles, CA;3Steadman-Hawkins Clinic, Vail, CO;4Thomas Jefferson University, Philadelphia, PA
OBJECTIVE(S): Athletic Pubalgia (AP) is a leading cause of athlete loss from competitive sports. Commonly misnamed “sports hernia,” AP is a set of pelvic injuries involving the abdominal and pelvic musculature outside the ball-in-socket hip joint and on both sides of the pubic symphysis. Injury results from hyper-extension of the abdomen and hyper-abduction of the thigh. Prospective studies show that timely intervention and appropriate repair of selected injuries results in a 95.4% two-year success rate in returning athletes to previous performance levels.
METHODS: This series of 8,490 patients resulted in 5,460 operations, the development of highly sensitive imaging techniques, and new training and rehabilitation protocols now incorporated into various levels of organized sports.
RESULTS:The operations have been on 17 different structures within the pelvis. Mean age has increased from 24.7 to 29.6 (range 12-73), and female:male ratio from 2.4% to 15.2%. The four most common non-musculoskeletal diagnoses found during work-up were: inflammatory bowel disease, endometriosis, urologic problems, and tumors. Simultaneous hip injury (HI) occurred with 8% incidence. New MRI techniques utilize coils to eliminate bone artifact, and new angling and zoom techniques; and have 91% diagnostic accuracy. Direct MRI-hip arthrography/sensorcaine test has 79% accuracy for HI. Performance training and rehabilitation utilize new devices and sequential firing techniques.
CONCLUSIONS:Athletic pubalgia (“sports hernia”) has a real anatomic and pathophysiologic basis. New technology aids in its prevention, diagnosis, and treatment. Recognition of the injuries and satisfactory care has returned many athletes to successful careers and has had a major impact on modern sport.