‘Treatment of the Sportsman's groin’: British Hernia Society's 2014 position statement based on the Manchester Consensus Conference

Abstract

IntroductionThe aim was to produce a multidisciplinary consensus to determine the current position on the nomenclature, definition, diagnosis, imaging modalities and management of Sportsman's groin (SG).MethodsExperts in the diagnosis and management of SG were invited to participate in a consensus conference held by the British Hernia Society in Manchester, UK on 11–12 October 2012. Experts included a physiotherapist, a musculoskeletal radiologist and surgeons with a proven track record of expertise in this field. Presentations detailing scientific as well as outcome data from their own experiences were given. Records were made of the presentations with specific areas debated openly.ResultsThe term ‘inguinal disruption’ (ID) was agreed as the preferred nomenclature with the term ‘Sportsman's hernia’ or ‘groin’ rejected, as no true hernia exists. There was an overwhelming agreement of opinion that there was abnormal tension in the groin, particularly around the inguinal ligament attachment. Other common findings included the possibility of external oblique disruption with consequent small tears noted as well as some oedema of the tissues. A multidisciplinary approach with tailored physiotherapy as the initial treatment was recommended with any surgery involving releasing the tension in the inguinal canal by various techniques and reinforcing it with a mesh or suture repair. A national registry should be developed for all athletes undergoing surgery.ConclusionsID is a common condition where no true hernia exists. It should be managed through a multidisciplinary approach to ensure consistent standards and outcomes are achieved.

Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging

“…106 Tearing of these tissues, widening and erosion of the pubic symphysis (osteitis pubis), and tearing of the adjacent oblique aponeuroses, either in isolation or combination, produce what is known as sports hernia, athletic pubalgia, or, more accurately, inguinal disruption. 106,107 This condition is more common in male athletes than in female athletes and is a source of anterior hip pain not attributable to internal derangement of the femoroacetabular joint. 106 Key features from the patient history include deep abdominal or inguinal pain that presents with activity and is relieved with rest.…”

Intraperitoneal onlay mesh reinforcement of the abdominal wall: a new surgical option for treatment of anterior cutaneous nerve entrapment syndrome—a retrospective cohort analysis of 30 consecutive patients

“…At that time, we found some support for this concept in a striking similarity between ACNES and sportsman's hernia, nowadays called inguinal disruption [7]. The basic Fig.…”

“…The recent British Hernia Society conference on inguinal disruption concluded that the most frequent causes of that syndrome are disruption or tears of the external oblique aponeurosis and/or the transversal fascia, resulting in weakness of the posterior wall of the inguinal canal [7]. If similar changes at the level of the posterior rectus sheath and the transversal fascia may be involved in the pathogenesis of ACNES, then reinforcement of the weakened abdominal wall at the painful area seems to make sense.…”

Sportlerleiste

“…Der Evidenz liegen nur Kasuistiken und Kohortstudien (Level III-IV) sowie Expertenmeinungen (Level V) zugrunde. Ein Positionspapier der Britischen Hernia Society besteht ebenfalls nur aus der Sammlung von Expertenmeinungen [24].…”