The purpose of this study was 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.
A systematic review was performed by searching PubMed, 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 diagnosis terminology, country of publication, preoperative diagnostic measures, surgical technique, and the subspecialty of the operating surgeons described in each article were extracted and reported.
Thirty-one studies met inclusion/exclusion criteria, including 3 surgical technique articles and 28 clinical articles (2 level I, 1 level II, 4 level III, 21 level IV evidence). 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 a CMI/athletic pubalgia/inguinal disruption. Tenderness to palpation was the most common technique performed during physical examination, though the specific locations assessed with this technique varied substantially. The operating surgeons were general surgeons (16 articles), a combination of orthopaedic/general surgeons (7 articles), or orthopaedic surgeons (5 articles). The most common procedures performed were an open or laparoscopic mesh repair, adductor tenotomy, primary tissue (hernia) repair, and rectus abdominis (RA) repair. The procedures performed differed based on surgeon subspecialty, geographic location, and year of publication.
A variety of diagnostic methods and surgical procedures have been used in the treatment of a core muscle injury/athletic pubalgia/sports hernia/inguinal disruption. These procedures are performed by orthopaedic and/or general surgeons, with the procedures performed differing based on surgeon subspecialty and geographic location.