The Surgical Approach to Athletic Pubalgia

Sports hernia refers to a condition in which there is chronic exertional lower abdominal/inguinal pain that limits athletic performance. The term sports hernia, although firmly ingrained in the lexicon, is a misnomer since it does not involve a true herniation of internal contents but rather broadly refers to conditions in which there are various injuries to structures associated with the pubis or pubic joint. As a result, Meyers proposed the term athletic pubalgia to more accurately reflect the various clinical and anatomic presentations and pathophysiology of this condition [1]. Other groups have also recommended various terminology that includes inguinal disruption as proposed by The British Hernia Society [2]. A consensus meeting in 2015 described a classification system based on the anatomic regions affected: adductor-related, iliopsoas-related, inguinal-related, and pubic-related [3]. While “athletic pubalgia” has been more commonly accepted amongst the sports medicine and surgical community, recently “core muscle injury” has been used because of the conceptual ease with the lay public [4].