title: Laparoscopic surgery for chronic groin pain in athletes is more effective than nonoperative treatment: a randomized clinical trial with magnetic resonance imaging of 60 patients with sportsman's hernia (athletic pubalgia).
abstract: BACKGROUND
  Chronic groin pain in athletes presents often a diagnostic and therapeutic challenge. Sportsman's hernia (also called "athletic pubalgia") is a deficiency of the posterior wall of the inguinal canal, which is often repaired by laparoscopic mesh placement. Endoscopic mesh repair may offer a faster recovery for athletes with sportsman's hernia than nonoperative therapy.
  
  
  METHODS
  A randomized, prospective study was conducted on 60 patients with a diagnosis of chronic groin pain and suspected sportsman's hernia. Clinical data and MRI were collected on all patients. After 3 to 6 months of groin symptoms, the patients were randomized into an operative or a physiotherapy group (n = 30 patients in each group). Operation was performed using a totally extraperitoneal repair in which mesh was placed behind the symphysis and painful groin area. Conservative treatment included at least 2 months of active physiotherapy, including corticosteroid injections and oral anti-inflammatory analgesics. The outcome measures were pre- and postoperative pain using a visual analogue scale and partial or full recovery to sports activity at 1, 3, 6, and 12 months after randomization.
  
  
  RESULTS
  The athletes in both treatment groups had similar characteristics and pain scores. Operative repair was more effective than nonoperative treatment to decrease chronic groin pain after 1 month and up to 12 months of follow-up (P < .001). Of the 30 athletes who underwent operation, 27 (90%) returned to sports activities after 3 months of convalescence compared to 8 (27%) of the 30 athletes in the nonoperative group (P < .0001). Of the 30 athletes in the conservatively treated group, 7 (23 %) underwent operation later because of persistent groin pain.
  
  
  CONCLUSIONS
  This randomized controlled study indicated that the endoscopic placement of retropubic mesh was more efficient than conservative therapy for the treatment of sportsman's hernia (athletic pubalgia).
authors.affiliation: Department of Surgery, Kuopio University Hospital, Kuopio, Finland. hannu.paajanen@kuh.fi
authors.forename: Hannu
authors.initials: H
authors.lastname: Paajanen
authors.forename: Tuomas
authors.initials: T
authors.lastname: Brinck
authors.forename: Heikki
authors.initials: H
authors.lastname: Hermunen
authors.forename: Ilari
authors.initials: I
authors.lastname: Airo
mesh_terms: D015746:Abdominal Pain / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D000328:Adult; D056352:Athletes; D001265:Athletic Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D002908:Chronic Disease; D005260:Female; D006119:Groin; D006552:Hernia, Inguinal / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome; D055815:Young Adult