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A European survey on the aetiology, investigation and management of the “Sportsman’s Groin”

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Abstract

Introduction

A sportsman’s groin has no accepted definition or consensus on treatment. The aim of this study was to assess current opinion among a large body of European surgeons using an online survey.

Methods

An online questionnaire comprising 16 multiple-choice questions was sent by email to general surgeons in Europe. The survey was live from the 6th to 30th September 2011.

Results

In total 143 responses were received. One hundred and six respondents (74 %) expressed experience in managing this condition. The majority (91 %) managed <26 cases per year. Posterior wall weakness (53 %), pubic tendinitis (43 %), nerve entrapment (37 %) and conjoint tendon injury (36 %) were the commonest aetiological factors described. Preferred diagnostic investigations were ultrasound of the groin (44 %) and MRI of the pelvis (29 %). The most common initial treatment (91 % of respondents) was conservative measures (rest and analgesia) for a maximum of 6-month period. When surgery was undertaken, Lichtenstein repair (29 %), TEP (27 %), TAPP (20 %), and posterior wall repair (21 %) were the commonest procedures. The majority (95 %) of respondents would not offer bilateral surgery for those presenting with unilateral groin pain.

Conclusions

Most European surgeons see <26 cases of “sportsman’s groin” per year, which is in keeping with the low incidence of this condition. There remains wide variation in its investigation and management, which reflects the differences in opinion on its aetiology. The majority of surgeons agree that surgery is not the only treatment option available, but there is little consensus on the optimal management.

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References

  1. Falvey EC, Franklyn-Miller A, McCrory PR (2009) The groin triangle: a patho-anatomical approach to the diagnosis of chronic groin pain in athletes. Br J Sports Med 43:213–220

    Article  CAS  PubMed  Google Scholar 

  2. Swan KG, Wolcott M (2007) The athletic hernia: a systematic review. Clin Orthop Relat Res 455:78–87

    Article  PubMed  Google Scholar 

  3. Farber AJ, Wilckens JH (2007) Sports hernia: diagnosis and therapeutic approach. J Am Acad Orthop Surg 15:507–514

    PubMed  Google Scholar 

  4. Diesen DL, Pappas TN (2007) Sports hernia. Adv Surg 41:177–187

    Article  PubMed  Google Scholar 

  5. Campanelli G (2010) Pubic inguinal pain syndrome: the so-called sports hernia. Hernia 14:1–4

    Article  CAS  PubMed  Google Scholar 

  6. Hackney RG (1993) The sports hernia: a cause of chronic groin pain. Br J Sports Med 27:58–62

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Meyers WC, McKechnie A, Philippon MJ, Horner MA, Zoga AC, Devon ON (2008) Experience with “sports hernia” spanning two decades. Ann Surg 248:656–665

    PubMed  Google Scholar 

  8. Muschaweck U, Berger LM (2010) Sportsmen’s groin-diagnostic approach and treatment with the minimal repair technique: a single-center uncontrolled clinical review. Sports Health 2:216–221

    Article  PubMed Central  PubMed  Google Scholar 

  9. Mann CD, Sutton CD, Garcea G, Lloyd DM (2009) The inguinal release procedure for groin pain: initial experience in 73 sportsmen/women. Br J Sports Med 43:579–583

    Article  CAS  PubMed  Google Scholar 

  10. Paajanen H, Brinck T, Hermunen H, Airo I (2011) Laparoscopic surgery for chronic groin pain in athletes is more effective than nonoperative treatment: a randomized clinical trial with magnetic resonance imaging of 60 patients with sportsman’s hernia (athletic pubalgia). Surgery 150:99–107

    Article  PubMed  Google Scholar 

  11. Hölmich P, Larsen K, Krogsgaard K, Gluud C (2010) Exercise program for prevention of groin pain in football players: a cluster-randomized trial. Scand J Med Sci Sports 20:814–821

    Article  PubMed  Google Scholar 

  12. Hölmich P, Uhrskou P, Ulnits L, Kanstrup IL, Nielsen MB, Bjerg AM, Krogsgaard K (1999) Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet 353:439–443

    Article  PubMed  Google Scholar 

  13. Weir A, Jansen JA, van de Port IG, Van de Sande HB, Tol JL, Backx FJ (2011) Manual or exercise therapy for long-standing adductor-related groin pain: a randomised controlled clinical trial. Man Ther 16:148–154

    Article  CAS  PubMed  Google Scholar 

  14. Comin J, Obaid H, Lammers G, Moore J, Wotherspoon M, Connell D (2013) Radiofrequency denervation of the inguinal ligament for the treatment of ‘sportsman’s hernia’: a pilot study. Br J Sports Med 47:380–386

    Article  PubMed  Google Scholar 

  15. Muschaweck U, Berger L (2010) Minimal repair technique of sportsmen’s groin: an innovative open-suture repair to treat chronic inguinal pain. Hernia 14:27–33

    Article  PubMed  Google Scholar 

  16. Gilmore OJA (1991) Gilmore’s groin: ten years experience of groin disruption—a previously unsolved problem in sportsmen. Sports Med Soft Tissue Trauma 3:12–14

    Google Scholar 

  17. Susmallian S, Ezri T, Elis M, Warters R, Charuzi I, Muggia-Sullam M (2004) Laparoscopic repair of “sportsman’s hernia” in soccer players as treatment of chronic inguinal pain. Med Sci Monit 10:CR52–CR54

    PubMed  Google Scholar 

  18. Srinivasan A, Schuricht A (2002) Long-term follow-up of laparoscopic preperitoneal hernia repair in professional athletes. J Laparoendosc Adv Surg Tech A 12:101–106

    Article  PubMed  Google Scholar 

  19. Paajanen H, Hermunen H, Karonen J (2008) Pubic magnetic resonance imaging findings in surgically and conservatively treated athletes with osteitis pubis compared to asymptomatic athletes during heavy training. Am J Sports Med 36:117–121

    Article  PubMed  Google Scholar 

  20. Robinson P, Barron DA, Parsons W, Grainger AJ, Schilders EM, O’Connor PJ (2004) Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings. Skeletal Radiol 33:451–457

    Article  CAS  PubMed  Google Scholar 

  21. Brennan D, O’Connell MJ, Ryan M, Cunningham P, Taylor D, Cronin C et al (2005) Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology 235:162–167

    Article  PubMed  Google Scholar 

  22. Robinson P, Bhat V, English B (2011) Imaging in the assessment and management of athletic pubalgia. Semin Musculoskelet Radiol 15:14–26

    Article  PubMed  Google Scholar 

  23. Zoga AC, Mullens FE, Meyers WC (2010) The spectrum of MR imaging in athletic pubalgia. Radiol Clin N Am 48:1179–1197

    Article  PubMed  Google Scholar 

  24. Koulouris G (2008) Imaging review of groin pain in elite athletes: an anatomic approach to imaging findings. AJR Am J Roentgenol 191:962–972

    Article  PubMed  Google Scholar 

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Conflict of interest

J.A.K. declares no conflict of interest, J.S. declares no conflict of interest, C.M. declares no conflict of interest, G.C. declares no conflict of interest, D.L. declares no conflict of interest and A.J.S. declares no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK

    J. A. Kingston, S. Jegatheeswaran, C. Macutkiewicz & A. J. Sheen

  2. Department of Surgery, Istitutoclinico Sant’Ambrogio, Milan, Italy

    G. Campanelli

  3. Department of Surgery, University Hospitals of Leicester, Leicester, UK

    D. M. Lloyd

Authors
  1. J. A. Kingston
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  2. S. Jegatheeswaran
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  3. C. Macutkiewicz
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  4. G. Campanelli
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  5. D. M. Lloyd
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  6. A. J. Sheen
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Corresponding author

Correspondence to A. J. Sheen.

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Kingston, J.A., Jegatheeswaran, S., Macutkiewicz, C. et al. A European survey on the aetiology, investigation and management of the “Sportsman’s Groin”. Hernia 18, 803–810 (2014). https://doi.org/10.1007/s10029-013-1178-4

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  • DOI: https://doi.org/10.1007/s10029-013-1178-4

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