E.M. Ayhan1, N.B. Wells1, J.A. Bonadies2 1Quinnipiac University, Frank H. Netter MD School Of Medicine, North Haven, CONNECTICUT, USA 2Hartford Healthcare, PACT Surgical Specialists, Hamden, CONNECTICUT, USA
Introduction: Sports hernias are a common condition that greatly impact function and quality of life for both athletes and non-athletes. While common, the anatomy and pathophysiology of sports hernias are poorly understood, making effective diagnosis and treatment challenging. Standardized categorization into distinct types may optimize definition and treatment. The goal of this work was to propose a novel categorization system for sports hernias to aid clinicians in identifying and treating patients at risk of poor outcomes.
Methods: Review of a prospective sports hernia registry from 2013-2024 was performed. Sports hernias were categorized into three types based on clinical presentation and MRI findings: adductor-dominant (AD), posterior wall deficient (PW), and combined adductor and posterior wall deficient (CAPW). Demographics and outcomes were analyzed in IBM SPSS 29 using multivariate logistic regression and compared across each type. The primary outcome measure was full resolution of symptoms. Secondary outcome measures included time to diagnosis, rate of surgical treatment, and rate of positive MRI.
Results: 368 patients were included, with 327 (88.9%) males, a mean age of 43 ± 16, and mean BMI of 27.72 ± 5.53. 101 (27.4%) patients were athletes, defined as ≥2 days of weekly participation in organized sport. Non-athlete status, older age, and prior history of inguinal hernia were significantly associated with AD type (P < 0.05). AD type had the longest time to diagnosis and lowest odds of exhibiting positive sports hernia findings on MRI compared to PW type (OR: 0.536, 95% CI [0.290, 0.991], P = 0.047). AD type had the highest rate of unresolved symptoms after treatment (67.1%). Across all types, surgical treatment, specifically robotic or laparoscopic mesh reinforcement of the inguinal floor, had significantly greater odds of achieving resolution compared to nonoperative treatment (OR: 6.792, 95% CI [3.825, 12.059], P < 0.001). Patients with AD type had significantly lower odds of undergoing surgery compared to PW type (OR: 0.189, 95% CI [0.099, 0.362], P < 0.001).
Conclusion: These findings highlight the potential value of the standardized categorization of sports hernias by clinical presentation and MRI findings. Surgical treatment with mesh reinforcement of the inguinal floor should be considered the gold-standard treatment for all sports hernias. Of the proposed types, AD is associated with delayed diagnosis, lowest rate of surgical treatment, and ongoing symptoms even after surgery. The low rate of surgery for the AD type suggests a gap in current treatment approaches. The proposed categorization system can help guide shared decision making and identify patients at risk of poor outcomes.