Groin pain from sports hernia surgery and treatment outcomes

Abstract

<h4>Background</h4>Groin pain syndrome (GPS) is a complex pathology of the pubic joint resulting from excessive torque on the pubic symphysis and surrounding structures. Although broadly recognized as a sports-related injury, GPS also affects nonathletes due to physical demands common in occupational labor or routine physical activity. Surgical management has demonstrated favorable outcomes in athletes, but its role in the general population remains uncertain.<h4>Purpose</h4>(1) To compare surgical and nonsurgical outcomes in athletes versus nonathletes with GPS and (2) to compare outcomes between different surgical techniques for GPS.<h4>Study design</h4>Cohort study; Level of evidence, 3.<h4>Methods</h4>Patients treated for GPS between December 2013 and August 2024 were included. All patients were diagnosed clinically by physical examination and treated using a standardized diagnostic-therapeutic algorithm. Complete symptom resolution and residual pain on physical examination were compared between athletes and nonathletes for surgical and nonsurgical treatment. All patients were followed until complete resolution or treatment completion and assessed for long-term complications.<h4>Results</h4>A total of 250 patients with GPS were evaluated, including 75 athletes and 175 nonathletes, with a median symptom duration of 13 months. Overall, 202 patients (80.8%) were treated surgically, and 247 patients (98.8%) achieved either complete (n = 154, 61.6%) or partial (n = 93, 37.2%) resolution of symptoms. Athletes demonstrated lower odds of residual pain than nonathletes (odds ratio [OR], 0.276; 95% CI, 0.098-0.778; <i>P</i> = .015). Surgery demonstrated lower odds of residual pain than no surgery (OR, 0.248; 95% CI, 0.100-0.614; <i>P</i> = .003), which remained significant only in the nonathlete subgroup analysis (OR, 0.164; 95% CI, 0.058-0.464; <i>P</i> < .001). Furthermore, the effect of surgery on residual pain was significantly modified by athletic status (<i>P</i> = .034). Robotic transabdominal preperitoneal (TAPP) mesh repair demonstrated higher odds of complete resolution (OR, 5.413; 95% CI, 1.837-15.949; <i>P</i> = .002) and lower odds of residual pain (OR, 0.152; 95% CI, 0.053-0.439; <i>P</i> < .001) than no surgery. Combined mesh repair and adductor tenotomy demonstrated higher odds of complete resolution (OR, 8.435; 95% CI, 1.648-43.181; <i>P</i> = .010) than no surgery.<h4>Conclusion</h4>Under a standardized diagnostic-therapeutic algorithm, both athletes and nonathletes with GPS demonstrated significant improvement. Surgery, particularly robotic TAPP mesh repair, significantly improved outcomes in nonathletes. These findings extend GPS management beyond the elite, young, male athlete.