Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2015; 3(9): 823-830
Published online Sep 16, 2015. doi: 10.12998/wjcc.v3.i9.823
Sports hernia and femoroacetabular impingement in athletes: A systematic review
Daniele Munegato, Marco Bigoni, Giulia Gridavilla, Stefano Olmi, Giovanni Cesana, Giovanni Zatti
Daniele Munegato, Marco Bigoni, Giulia Gridavilla, Giovanni Zatti, Clinica Ortopedica AO San Gerardo, Università degli Studi di Milano Bicocca, 20900 Monza, Italy
Stefano Olmi, Giovanni Cesana, Policlinico San Marco, University and Research Hospital, 24040 Zingonia, Verdellino, Italy
Author contributions: Munegato D, Bigoni M, Olmi S and Zatti G contributed to the conception and design of the study; Munegato D, Gridavilla G and Cesana G performed the research and wrote the paper; Bigoni M and Olmi S critically revised the paper; Zatti G approved the final version of the article to be submitted.
Conflict-of-interest statement: All authors declare that there are no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Daniele Munegato, MD, Clinica Ortopedica AO San Gerardo, Università degli Studi di Milano Bicocca, Via Pergolesi 33, 20900 Monza, Italy. munegato.daniele@gmail.com
Telephone: +39-328-6654166
Received: November 29, 2014
Peer-review started: November 29, 2014
First decision: December 26, 2014
Revised: April 2, 2015
Accepted: July 7, 2015
Article in press: July 8, 2015
Published online: September 16, 2015
Processing time: 290 Days and 11.4 Hours
Abstract

AIM: To investigate the association between sports hernias and femoroacetabular impingement (FAI) in athletes.

METHODS: PubMed, MEDLINE, CINAHL, Embase, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched for articles relating to sports hernia, athletic pubalgia, groin pain, long-standing adductor-related groin pain, Gilmore groin, adductor pain syndrome, and FAI. The initial search identified 196 studies, of which only articles reporting on the association of sports hernia and FAI or laparoscopic treatment of sports hernia were selected for systematic review. Finally, 24 studies were reviewed to evaluate the prevalence of FAI in cases of sports hernia and examine treatment outcomes and evidence for a common underlying pathogenic mechanism.

RESULTS: FAI has been reported in as few as 12% to as high as 94% of patients with sports hernias, athletic pubalgia or adductor-related groin pain. Cam-type impingement is proposed to lead to increased symphyseal motion with overload on the surrounding extra-articular structures and muscle, which can result in the development of sports hernia and athletic pubalgia. Laparoscopic repair of sports hernias, via either the transabdominal preperitoneal or extraperitoneal approach, has a high success rate and earlier recovery of full sports activity compared to open surgery or conservative treatment. For patients with FAI and sports hernia, the surgical management of both pathologies is more effective than sports pubalgia treatment or hip arthroscopy alone (89% vs 33% of cases). As sports hernias and FAI are typically treated by general and orthopedic surgeons, respectively, a multidisciplinary approach for diagnosis and treatment is recommended for optimal treatment of patients with these injuries.

CONCLUSION: The restriction in range of motion due to FAI likely contributes to sports hernias; therefore, surgical treatment of both pathologies represents an optimal therapy.

Keywords: Athletic pubalgia; Groin pain; Laparoscopic treatment; Femoroacetabular impingement; Sports hernia

Core tip: Sports hernia and femoroacetabular impingement (FAI) are two pathologies frequently reported in athletes, which are independently treated by general surgeons and orthopedists, respectively. An association between these two entities has recently been recognized, and this review was conducted to define the prevalence of FAI in patients with sports hernia and evaluate the proposed pathogenic mechanism connecting them. Although the range of terms used to describe groin pain throughout the literature is varied, there is a high prevalence of FAI with sports hernias, for which the treatment of both pathologies is optimal.