Purpose
To perform a systematic review of reported terminologies, surgical techniques, preoperative
diagnostic measures, and geographic differences in the treatment of core muscle injury
(CMI)/athletic pubalgia/inguinal disruption.
Methods
A systematic review was performed by searching PubMed, the Cochrane Library, and Embase
to identify clinical studies or articles that described a surgical technique to treat
CMI refractory to nonoperative treatment. The search phrase used was “core muscle
injury” OR “sports hernia” OR “athletic pubalgia” OR “inguinal disruption.” The diagnostic
terminology, country of publication, preoperative diagnostic measures, surgical technique,
and subspecialty of the operating surgeons described in each article were extracted
and reported.
Results
Thirty-one studies met the inclusion and exclusion criteria, including 3 surgical
technique articles and 28 clinical articles (2 Level I evidence, 1 Level II, 4 Level
III, and 21 Level IV). A total of 1,571 patients were included. The most common terminology
used to describe the diagnosis was “athletic pubalgia,” followed by “sports hernia.”
Plain radiographs and magnetic resonance imaging of the pelvis were the most common
imaging modalities used in the preoperative evaluation of CMI/athletic pubalgia/inguinal
disruption. Tenderness-to-palpation testing was the most common technique performed
during physical examination, although the specific locations assessed with this technique
varied substantially. The operating surgeons were general surgeons (16 articles),
a combination of orthopaedic and general surgeons (7 articles), or orthopaedic surgeons
(5 articles). The most common procedures performed were open or laparoscopic mesh
repair, adductor tenotomy, primary tissue (hernia) repair, and rectus abdominis repair.
The procedures performed differed on the basis of surgeon subspecialty, geographic
location, and year of publication.
Conclusions
A variety of diagnostic methods and surgical procedures have been used in the treatment
of a CMI/athletic pubalgia/sports hernia/inguinal disruption. These procedures are
performed by orthopaedic and/or general surgeons, with the procedures performed differing
on the basis of surgeon subspecialty and geographic location.
Level of Evidence
Level V, systematic review of Level I to V studies.
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Article info
Publication history
Published online: April 09, 2021
Accepted:
March 17,
2021
Received:
August 4,
2020
Footnotes
See commentary on page 2391
The authors report the following potential conflicts of interest or sources of funding: O.M-D. receives intellectual property royalties from Stryker, owns stock or stock options in MITA, and receives research support from Stryker, outside the submitted work. C.M.L. is a consultant for Smith & Nephew, outside the submitted work. A.J.S. is a consultant for Mitek and receives research support from Biologics, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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