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Groin pain is a catch all phrase used to define a common set of symptoms that affect many individuals. It is a common condition affecting sportsmen and women (1, 2) and is often referred to as the sportsman groin (SG). Multiple surgical operations have been developed to treat these symptoms yet no definitive imaging modalities exist to diagnose or predict prognosis. This article aims to discuss the anatomy of the groin, suggest a biomechanical pathophysiology and outline a logical surgical solution to treat the underlying pathology. A systematic clinical and imaging approach with inguinal ligament and pubic specific MRI assessment, can result in accurate selection for intervention. Close correlation with clinical examination and imaging in series is recommended to avoid misinterpretation of chronic changes in athletes.
BACKGROUND: Sportsman’s groin, more accurately termed inguinal disruption or inguinal-related groin pain, represents a complex and heterogeneous clinical entity. Despite growing consensus on terminology and advances in imaging modalities and rehabilitation strategies, significant uncertainty remains regarding optimal management, particularly in relation to surgical intervention. METHODS: This narrative review evaluates the current literature on the diagnosis, nomenclature, and surgical management of sportsman’s groin. Emphasis is placed on the quality of available evidence, including the predominance of retrospective series and technique-specific reports, as well as the limited number of randomised controlled trials. RESULTS: Surgical treatment is recognised as an appropriate option in selected patients who fail conservative management. However, the evidence base is limited, with only one randomised controlled trial reported to date. Diagnostic challenges persist, particularly in relation to clinical heterogeneity and the limitations of imaging in accurately identifying the underlying pathology. Current studies largely focus on comparisons between open and laparoscopic techniques, with insufficient attention given to the fundamental distinction between mesh-based and suture-based repairs. CONCLUSION: Sportsman’s groin remains a poorly defined and variably managed condition. There is a clear need for improved diagnostic stratification to guide treatment selection. Future research should prioritise high-quality randomised controlled trials, with particular focus on the comparative effectiveness of mesh versus suture repair, rather than solely on surgical approach.
Wild turkeys (Meleagris gallopavo) are hosts to several vector-borne haemosporidian blood parasites that can cause morbidity and mortality in wild and domestic turkeys. This study investigated the prevalence, geographical distribution, and genetic diversity of haemosporidians in 942 wild turkeys from the USA and 12 ocellated turkeys (Meleagris ocellata) from Belize. Haemoproteus was detected in 69% (650/942) of USA turkeys. Sequencing revealed six unique haplotypes in two lineages (1a-1c and 2a-2c). Haplotypes 1a-1c were 99.4-99.8% similar, and Haplotype 1a was identical to a Haemoproteus reported in northern bobwhite (Colinus virginianus). Haplotypes 2a-2c were 98.2-99.2% similar, and Haplotype 2a was most similar (99.1%) to Haemoproteus reported from galliforms in Austria and Thailand. Lineage 1 sequences were only 96.9-98.2% similar to Lineage 2. Lineage 1 (1a-1c) was detected in 84.6% (523/618) of Haemoproteus-positive USA turkeys, with Haplotype 1a being most common (81.9%, 506/618). Lineage 2 (2a-2c) was detected in 43.4% (268/618) of USA turkeys. Leucocytozoon was detected in 9.7% (91/942) of USA wild turkeys, and all were identical to a Leucocytozoon from northern bobwhite. Haemoproteus prevalence was higher in males vs females and adults vs juveniles, and Leucocytozoon prevalence was higher in adults vs juveniles. No Plasmodium infections were detected. Haemoproteus was the only parasite detected in ocellated turkeys; 12 (100%) were infected with Lineage 1a, and four (33.3%) were co-infected with Lineage 2a. These findings provide new insights into the prevalence and genetic diversity of haemosporidians in turkeys.
To describe a refined endoscopic Totally Extraperitoneal Release & Reinforce (TEP-RRT) technique for sportsman's hernia and athletic pubalgia (SH/AP) with structured rehabilitation program and to present descriptive long-term results from a nine-year clinical series. Between January 2016 and April 2024, a consecutive series of 461 athletes with chronic SH/AP grade 4 to 5 underwent bilateral TEP-RRT by a single surgeon after failure of conservative treatment. The technique involves endoscopic extraperitoneal access, meticulous release of pubic bone (PB) complex adhesions and inflamed inguinal ligament (IL) responsible for neural entrapment, followed by pre-peritoneal reinforcement with a mid-weight mesh. A standardized postoperative structured rehabilitation program (PSRP) was initiated seven days postoperatively. Nine years long-term outcomes were assessed retrospectively using a standardized telephone survey conducted between September 2024 and March 2025. All 461 athletes (447 primary cases and 14 revision cases following failed SH/AP surgery performed at other centers) completed a survey-based postoperative follow-up, ranging from 6 months to 9 years. Overall, 98.5% (454/461) returned to sports activity and remained active, 75% resumed activity within 8 weeks, including all revision cases. No recurrences were reported during the follow-up period. Complications were infrequent (1.5%). TEP-RRT combined with a PSRP is a feasible, safe, and durable technique for primary and revision SH/AP cases.
Objective This study aimed to assess the quality and readability of online information available to patients on Google regarding Gilmore's groin. Methods This descriptive cross-sectional study evaluated webpages identified through Google searches using the terms "sports hernia", "athletic pubalgia", "Gilmore's groin", "sportsman's hernia", and "hockey hernia". The first page of results for each search term was screened. Duplicate links, non-functioning pages, and irrelevant results were excluded. Unique webpages meeting the eligibility criteria were analysed. Readability was assessed using the Gunning Fog Index (GFI), Flesch-Kincaid Grade Level (FKGL), and Flesch Reading Ease (FRE) score. Each webpage was further evaluated for source type, intended audience, presence of relevant media, inclusion of key clinical information, and quality using the Journal of the American Medical Association (JAMA) benchmark criteria. Descriptive statistics were used to summarise the findings. Results A total of 26 unique webpages were included. Hospital or clinic websites accounted for 13 (50%) webpages, and 16 (62%) were primarily directed toward patients. Relevant images were present in 11 (42%) webpages and relevant videos in three (11.5%). Information on cause and symptoms was provided in 26 (100%) webpages, investigations in 22 (85%), treatment in 25 (96%), and prognosis in 15 (58%). With respect to JAMA benchmarks, authorship was reported in 16 (61.5%) webpages, attribution in 13 (50%), disclosure in 21 (81%), and currency in 17 (65%). Mean readability scores were 11.5 for GFI, 9.9 for FKGL, and 43.5 for FRE, indicating that the material was generally written above the recommended reading level for patient education resources. Conclusion Online patient information on Gilmore's groin is widely available but is typically written at a reading level that is too advanced for the general public. Improving readability while maintaining accuracy may enhance patient understanding, support shared decision-making, and improve access to health information.
Sportsman's hernia is very frequent in some sports, particularly in football. This painful syndrome is reported by high-level athletes as well as amateurs. There is no consensus about the management of sportsman's hernia, because of the heterogeneity in anatomoclinic forms. In case of surgical indication, the Nesovic procedure, also named "fasciomyoplasty", is one of the recommended procedures for the abdomino-parietal forms. Our objective was to report our experience with this procedure in terms of short- and mid-term results. All the patients who underwent Nesovic procedure between January 2009 and December 2022 in our center were retrospectively reviewed. 43 patients (98% men; mean age: 29.5 ± 9.2 years) were included. 37% of patients were professional athletes. The median time from symptoms' onset to diagnosis was 3 months (range = 1-72 months). The median time from diagnosis to surgery was 7 months (range = 1-58 months). Postoperative overall morbidity occurred in six patients (14%), including scrotum swelling (n = 2), hematoma (n = 1), serous collection (n = 1) and acute urinary retention (n = 2). No major complication occurred. At the end of follow-up (median: 1 year; range = 1 month-11 years), 84% of patients recovered their previous sports activity, after a mean delay of 2 months. Nesovic procedure is efficient in more than 80% of sports patients without any major morbidity.
Athletic pubalgia is a relatively uncommon injury that is not fully understood. There are few high-level studies comparing treatments of athletic pubalgia, and this investigation seeks to utilize original articles to compare two common techniques for treatment of athletic pubalgia. The purpose of this study is to compare two prominent procedures, i.e., rectus abdominus repair and posterior wall reinforcement, through a systematic review. Inclusion/exclusion criteria were identified and then applied to search strategies in PubMed and MEDLINE. Two reviewers screened articles based on the agreed-upon criteria in a primary screen of titles and abstracts and a secondary screen of full-text articles. A total of 59 full-text articles were reviewed, and 13 were selected for this study. The study designs included seven prospective cohort studies, five retrospective cohort studies, and one randomized control trial. There were five studies with rectus abdominus repair intervention and eight studies with posterior wall reinforcement intervention. The median age range was 22-32. The mean follow-up time ranged from one month to 12.5 years. The success rate ranged from 76% to 96% for rectus abdominus repair and from 72% to 98% for posterior wall reinforcement. The two procedures performed about the same as the success rate for both procedures ranged from about 70% to 90%. The lack of standardization in clinical outcomes makes comparison across studies difficult. It is hard to discern which procedure actually performs better, and thus future research in this area needs to be conducted to focus on more specific outcomes, frequent follow-up, and standardization of outcome measures.
Sportsman's Hernia and Athletic Pubalgia (SH/AP) typically develop as a result of muscle imbalance and continuous sports-related microtrauma to the groin area. The injury progresses through two phases: initially, SH is localized in the groin soft tissues, while in the advanced stage, AP extends the injury to the pubic bone. Despite increasing clinical recognition of SH/AP, high-quality, large-scale studies remain limited. As a result, extensive clinical experience may help inform understanding and managing the different phases of the injury. This narrative review aims to stream the authors' expertise-based on approximately 30 years of hands-on experience in diagnosing, treating, and endoscopically managing SH/AP-into a scientific literature and real-world clinical practice. An extensive literature review was conducted to present the current knowledge of diagnostic tests, imaging, endoscopic surgery and rehabilitation treatment of SH/AP. Where appropriate, clinical observations drawn from over three decades of surgical experience with SH/AP patients are used to contextualize the evidence. MRI is a primary imaging tool for suspected SH/AP, particularly in advanced cases or when nerve involvement is suspected but multiple imaging findings may also be present in asymptomatic athletes. Clinical history and physical examination remain crucial in making the diagnosis of SH/AP, guiding imaging decisions as auxiliary test. Surgical treatment of SH/AP is may be indicated after 2-3 months of failed conservative treatment. The totally extraperitoneal (TEP) without or with release of inguinal ligament (TEP-RRT) approaches have been described in the literature with favorable outcomes. Postoperative rehabilitation plays a critical role in functional recovery. Physical examination and endoscopic surgery remain most effective in SH/AP according literature and authors experience, followed by dedicated controlled athletics muscles rehabilitation program.
This article critically examines long-standing groin pain (LSGP) in physically active adults related to sports overload by analyzing terminology, pathophysiology, and treatment. This review is based on data from over 10,000 patients managed through a multidisciplinary algorithm. (LSGP) has been variably labeled, using terms that have led to inconsistencies in understanding its origin and management. Terms such as "Pubic Inguinal Pain Syndrome," "Sportsman's Groin," and "Athletic Pubalgia" have been proposed to standardize terminology and unify the classification of (LSGP). Pathophysiologically, (LSGP) is often due to tendinopathies affecting major tendons in the groin region, such as the adductors, iliopsoas, conjoint tendon, and inguinal ligament, often associated with weakness in the posterior wall of the inguinal canal. This condition frequently arises in sports involving abrupt directional changes and high-energy loads in the groin. Tendinopathies progress through reactive, reparative, or degenerative stages of tendinosis. Literature supports a multidisciplinary approach involving surgeons, physiotherapists, sports medicine physicians, and orthopedists for accurate diagnosis and effective treatment. Our algorithm focuses on both anatomical and functional factors in managing (LSGP). Initial conservative therapies aim to support tendon regeneration and load correction, while surgical interventions, such as laparoscopic hernioplasty, are reserved for non-responsive cases. From 2004 to 2024, 12,144 patients completed this protocol, with only 14% requiring surgery. Long-term follow-up demonstrated a low recurrence rate of tendinopathy and an absence of severe complications. Standardizing terminology, understanding pathophysiology, and utilizing a multidisciplinary approach are essential for optimizing the diagnosis and management of sports-related (LSGP).
Trichomonas gypaetinii was detected in 117 (88%) of 133 Bald Eagles (Haliaeetus leucocephalus) and in 0/7 Golden Eagles (Aquila chrysaetos) in the USA, with no sex or age prevalence difference. All eagles lacked associated lesions. This study indicated that T. gypaetinii is common and widespread in Bald Eagles, but rarely associated with disease.
Wild turkeys (Meleagris gallopavo) are an important game species throughout the geographic range. Populations throughout multiple regions of the US have been declining, including in Kentucky, US, raising concerns among managers and resource users. To better understand the overall population health, we performed postmortem examinations and targeted pathogen, mineral, and toxicant testing on 36 adult male, apparently healthy, wild turkeys that were hunter harvested in western Kentucky during April 2018. We found that birds were in fair to good nutritional condition with no significant gross or microscopic lesions. Ticks (Amblyomma spp.) and lice (three species) were present on 94 and 31% of birds, respectively. We commonly detected intestinal nematodes and cestodes and found coccidian oocysts in 39% and capillarid eggs in 6% of birds. The prevalences of lymphoproliferative disease virus and reticuloendotheliosis virus were 39 and 11%, respectively. Spleen samples tested with PCR were positive for Borrelia burgdorferi, Haemoproteus sp., and Leucocytozoon sp. in 11, 83, and 3%, respectively. Based on a subjective histologic assessment of testis tissues, most birds had widespread and abundant sperm present. Mineral analysis and broad toxicant screening on liver samples from 32 turkeys were unremarkable. Further work is needed to assess potential population risk factors and to determine individual- and population-level impacts of pathogens on adults and poults.
Sports hernias are a complex cause of chronic groin pain in athletes, posing diagnostic and treatment challenges for clinicians. This review article synthesizes current knowledge on sports hernias, exploring pathogenesis, diagnostic approaches, and management strategies. Despite the growing body of research, sports hernias continue to present a significant challenge, necessitating a multidisciplinary approach and further research to improve clinical outcomes. This comprehensive review aims to equip clinicians with an updated understanding of sports hernias, ensuring optimal patient care and informing future research.
Evaluating groin pain still evades many clinicians at times as they have difficulty determining the cause of pain when no true hernia exists. This study's aim was to evaluate a simple and novel scoring system which is reproducible, to help determine whether conservative measures or surgery is recommended for the management of groin pain attributable to inguinal disruption. A retrospective analysis of all patients from 2018 to 2020 that underwent surgery or conservative management for inguinal disruption with at least a 1-year follow-up were evaluated. The scoring system is based on MRI and ultrasound imaging as well as clinical findings, with scores given from - 2 to + 2 based on the defined findings listed. A maximum total of four points scored for each assessment was used. Sensitivity and specificity analysis was conducted for each potential score cut off point. A total of 172 patients were evaluated with 33 patients (19%) undergoing conservative management and 139 patients (81%) undergoing surgery. The median SPoRT score for the surgery group was 2.0 (1.0, 3.0), and - 1.0 (- 3.0, 0.0) in the physiotherapy group which was a significant difference (p < 0.001). An optimal cut off of ≤ 0 for physio and ≥ 1 for surgery was established, yielding a sensitivity of 90.9% (95% CI 75.7%-98.1%), a specificity of 89.2% (95% CI 82.8%-93.8%) and an area under the curve (AUC) of 0.936 (95% CI 0.874-0.997). SPoRT score of ≤ 0 can recommend a patient should undergo conservative measures or physiotherapy as a mainstay of treatment with a score of ≥ 1 recommending surgery. Further validation of the score is necessary.
Groin pain is a common symptom in athletes. The complex anatomy of the area and the various terms used to describe the etiology behind groin pain have led to a confusing nomenclature. To solve this problem, three consensus statements have been already published in the literature: the Manchester Position Statement in 2014, the Doha agreement in 2015, and the Italian Consensus in 2016. However, when revisiting recent literature, it is evident that the use of non-anatomic terms remains common, and the diagnoses sports hernia, sportsman's hernia, sportsman's groin, Gilmore's groin, athletic pubalgia, and core muscle injury are still used by many authors. Why are they still in use although rejected? Are they considered synonyms, or they are used to describe different pathology? This current concepts review article aims to clarify the confusing terminology by examining to which anatomical structures authors refer when using each term, revisit the complex anatomy of the area, including the adductors, the flat and vertical abdominal muscles, the inguinal canal, and the adjacent nerve branches, and propose an anatomical approach, which will provide the basis for improved communication between healthcare professionals and evidence-based treatment decisions.
We captured a <1-d-old male elk calf (Cervus canadensis) with a shortened neck. Postmortem examination revealed trauma, meconium aspiration syndrome, and cervical vertebral malformation (partial fusion and narrowed disc spaces). This observation is novel in a wild elk calf, although the gross lesions resembled complex vertebral malformation in neonatal cattle.
Sportsman's hernia is a painful syndrome in the inguinal area occurring in patients who play sports at an amatorial or professional level. Pain arises during sport, and sometimes persists after activity, representing an obstacle to sport resumption. A laparoscopic/endoscopic approach is proposed by many authors for treatment of the inguinal wall defect. Aim of this study is to assess the open technique in terms of safety and effectiveness, in order to obtain the benefit of an open treatment in an outpatient management. From October 2017 to July 2019, 34 patients underwent surgery for groin pain syndrome. All cases exhibited a bulging of the inguinal posterior wall. 14 patients were treated with Lichtenstein technique with transversalis fascia plication and placement of a polypropylene mesh fixed with fibrin glue. In 20 cases, a polypropylene mesh was placed in the preperitoneal space. The procedure was performed in day surgery facilities. Early or late postoperative complications did not occur in both groups. All patients returned to sport, in 32 cases with complete pain relief, whereas 2 patients experienced mild residual pain. The average value of return to sport was 34.11 ± 8.44 days. The average value of return to play was 53.82 ± 11.69 days. With regard to postoperative pain, no substantial differences between the two techniques were detected, and good results in terms of the resumption of sport were ensured in both groups. Surgical treatment for sportsman's hernia should be considered only after the failure of conservative treatment. The open technique is safe and allows a rapid postoperative recovery.
Regular exercise promotes structural, functional, and electrical remodeling of the heart, often referred to as the "athlete's heart," with intense endurance sports being associated with the greatest degree of cardiac remodeling. However, the extremes of exercise-induced cardiac remodeling are potentially associated with uncommon side effects. Atrial fibrillation is more common among endurance athletes and there is speculation that other arrhythmias may also be more prevalent. It is yet to be determined whether this arrhythmic susceptibility is a result of extreme exercise remodeling, genetic predisposition, or other factors. Gender may have the greatest influence on the cardiac response to exercise, but there has been far too little research directed at understanding differences in the sportsman's vs sportswoman's heart. Here in part 4 of a 4-part seminar series, the controversies and ambiguities regarding the athlete's heart, and in particular, its arrhythmic predisposition, genetic, and gender influences are reviewed in depth.
and importance: TEP might be one of options for treating such a sports hernia. An 18-year-old Japanese male presented with right groin pain for approximately two years. The pain was initially felt on the right side only, especially on kicking. We assessed the patient using laparoscopic examination with an intra-abdominal scope and subsequently diagnosed a sports hernia with a bilateral internal inguinal hernia. We then performed total extraperitoneal repair (TEP) for its treatment. The patient had a good postoperative course and was discharged from our hospital in remission after 3 days. Finally, the patient was able to play soccer without groin pain. Chronic groin pain in athletes can be caused by a bulge in the posterior inguinal wall, consistent with an incipient direct inguinal hernia. We show that intraperitoneal examination with TEP might be one of options for treating such a sports hernia. Endoscopic placement of the retropubic mesh must be considered an important option for this type of hernia.
Inguinal disruption (ID) is a condition of chronic groin pain affecting mainly athletes. ID cannot be defined as a true hernia. Pathogenesis is multifactorial due to repetitive and excessive forces applied to the inguino-pelvic region. Examination reveals tenderness to palpation of the inguinal region. Differential diagnosis is challenging; imaging is helpful for excluding other pathologies. Surgery is the treatment of choice when conservative treatment fails. Primary aim of the study was to evaluate the time to return to full sport activity after transabdominal preperitoneal patch plasty (TAPP) technique in ID. Secondary aim was to evaluate the postoperative complication rate both in the immediate post-operative time and in 1 year follow-up and to verify the relapse rate after surgery. In this study, we consider time to return to full sport activity as the time needed to return to pre-injury sport activity. A retrospective study is reported by evaluating 198 cases of ID from a single surgeon experience. All patients failed a previous conservative treatment. All cases were treated with the TAPP approach. Time to return to full sport activity was 4 weeks for 94.4% of patients, with a total of 98.5% of active patients at 9 months. Post-operative inguinal pain was the main complication (9.1%). On 13 years follow-up, we report a recurrence rate of 2.5%. Current management algorithm for ID, in professional athletes, supports the role of surgery after at least 2 months of conservative treatment. Recently, the role of surgery has been highlighted for a definitive treatment and a faster full recovery to sport activity, especially for elite professional athletes. In our opinion, laparoscopic surgery is the mainstay for non-responsive ID treatment. We present a long-term retrospective evaluation of a wide cohort of professional athletes diagnosed and treated in a systematic way.
The "sportsman's hernia" commonly presents as a painful groin in those sports that involve kicking and twisting movements while running, particularly in rugby, football, soccer, and ice hockey players. Moreover, sportsman's hernia can be encountered even in normally physically active people. The pain experienced is recognized at the common point of origin of the rectus abdominis muscle and the adductor longus tendon on the pubic bone and the insertion of the inguinal ligament on the pubic bone. It is accepted that this chronic pain caused by abdominal wall weakness or injury occurs without a palpable hernia. We proposed the new name "pubic inguinal pain syndrome." In the period between January 2006 and November 2013 all patients afferent in our ambulatory clinic for chronic groin pain without a clinically evident hernia were assessed with medical history, physical examination, dynamic ultrasound, and pelvic and lumbar MRI. All patients were proposed for a conservative treatment and then, if it was not effective, for a surgical treatment. Our etiopathogenetic theory is based on three factors: (1) the compression of the three nerves of the inguinal region, (2) the imbalance in strength of adductor and abdominal wall muscles caused by the hypertrophy and stiffness of the insertion of rectus muscle and adductor longus muscle, and (3) the partial weakness of the posterior wall. Our surgical procedure includes the release of all three nerves of the region, the correction of the imbalance in strength with the partial tenotomy of the rectus and adductor longus muscles, and the repair of the partial weakness of the posterior wall with a lightweight mesh. This treatment reported excellent results with complete relief of symptoms after resumption of physical activity in all cases.