Performance and Return to Sport After Sports Hernia Surgery in NFL Players

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2017 Apr 29

PMID 28451612

Citations 10

Authors

Robert A Jack

David C Evans

Anthony Echo

Patrick C McCulloch

David M Lintner

Kevin E Varner

Joshua D Harris

Affiliations

Soon will be listed here.

Abstract

Background: Recognition, diagnosis, and treatment of athletic pubalgia (AP), also known as sports hernia, once underrecognized and undertreated in professional football, are becoming more common. Surgery as the final treatment for sports hernia when nonsurgical treatment fails remains controversial. Given the money involved and popularity of the National Football League (NFL), it is important to understand surgical outcomes in this patient population.

Hypothesis: After AP surgery, players would: (1) return to sport (RTS) at a greater than 90% rate, (2) play fewer games for fewer years than matched controls, (3) have no difference in performance compared with before AP surgery, and (4) have no difference in performance versus matched controls.

Study Design: Cohort study; Level of evidence, 3.

Methods: Internet-based injury reports identified players who underwent AP surgery from January 1996 to August 2015. Demographic and performance data were collected for each player. A 1:1 matched control group and an index year analog were identified. Control and case performance scores were calculated using a standardized scoring system. Groups were compared using paired Student tests.

Results: Fifty-six NFL players (57 AP surgeries) were analyzed (mean age, 28.2 ± 3.1 years; mean years in NFL at surgery, 5.4 ± 3.2). Fifty-three players were able to RTS. Controls were in the NFL longer ( < .05) than players who underwent AP surgery (3.8 ± 2.4 vs 3.2 ± 2.1 years). Controls played more games per season ( < .05) than post-AP players (14.0 ± 2.3 vs 12.0 ± 3.4 games per season). There was no significant ( > .05) difference in pre- versus post-AP surgery performance scores and no significant ( > .05) difference in postoperative performance scores versus controls post-index.

Conclusion: There was a high RTS rate after AP surgery without a significant difference in postoperative performance, though career length and games per season after AP surgery were significantly less than that of matched controls.

Citing Articles

Surgically Treated Pectoralis Major Tears Impact the Play and Performance of National Football League Athletes.

Farooq H, Garbis N, Moossighi R, Lam R, Cho E, Salazar D Arthrosc Sports Med Rehabil. 2022; 4(5):e1807-e1812.

PMID: 36312700 PMC: 9596900. DOI: 10.1016/j.asmr.2022.07.009.

Thoracic Outlet Syndrome in Major League Baseball Pitchers: Return to Sport and Performance Metrics After Rib Resection.

Arnold M, Hart C, Greig D, Trikha R, Gelabert H, Jones K Orthop J Sports Med. 2022; 10(4):23259671221079835.

PMID: 35494495 PMC: 9047814. DOI: 10.1177/23259671221079835.

High Return to Play Rate and Reduced Career Longevity Following Surgical Management of Athletic Pubalgia in National Basketball Association Players.

Castle J, Kessler A, Abbas M, Wager S, Khalil L, Okoroha K Arthrosc Sports Med Rehabil. 2021; 3(5):e1359-e1365.

PMID: 34712974 PMC: 8527258. DOI: 10.1016/j.asmr.2021.07.001.

Return-to-Sport Time and Postoperative Performance in MLB Players Undergoing Wrist Arthroscopy.

Orozco E, Guloy A, Cotton M, Jack R, Liberman S Hand (N Y). 2021; 17(6):1269-1277.

PMID: 34433335 PMC: 9608293. DOI: 10.1177/15589447211028923.

Use of Preoperative Magnetic Resonance Imaging to Predict Clinical Outcomes After Core Muscle Injury Repair.

Kraeutler M, Kurowicki J, Davila Castrodad I, Milman E, Talishinskiy T, Scillia A Orthop J Sports Med. 2021; 9(4):2325967121995806.

PMID: 33889646 PMC: 8033399. DOI: 10.1177/2325967121995806.

References

Smedberg S, Broome A, Elmer O, GULLMO A . Herniography: a diagnostic tool in groin symptoms following hernial surgery. Acta Chir Scand. 1986; 152:273-7. View

Hsu W . Performance-based outcomes following lumbar discectomy in professional athletes in the National Football League. Spine (Phila Pa 1976). 2010; 35(12):1247-51. DOI: 10.1097/BRS.0b013e3181bf8bb5. View

Erickson B, Harris J, Cvetanovich G, Bach B, Bush-Joseph C, Abrams G . Performance and Return to Sport After Anterior Cruciate Ligament Reconstruction in Male Major League Soccer Players. Orthop J Sports Med. 2015; 1(2):2325967113497189. PMC: 4555483. DOI: 10.1177/2325967113497189. View

Erickson B, Harris J, Heninger J, Frank R, Bush-Joseph C, Verma N . Performance and return-to-sport after ACL reconstruction in NFL quarterbacks. Orthopedics. 2014; 37(8):e728-34. DOI: 10.3928/01477447-20140728-59. View

Draovitch P, Edelstein J, Kelly B . The layer concept: utilization in determining the pain generators, pathology and how structure determines treatment. Curr Rev Musculoskelet Med. 2012; 5(1):1-8. PMC: 3535125. DOI: 10.1007/s12178-011-9105-8. View

Cerynik D, Lewullis G, Joves B, Palmer M, Tom J . Outcomes of microfracture in professional basketball players. Knee Surg Sports Traumatol Arthrosc. 2009; 17(9):1135-9. DOI: 10.1007/s00167-009-0765-5. View

Sheen A, Stephenson B, Lloyd D, Robinson P, Fevre D, Paajanen H . 'Treatment of the sportsman's groin': British Hernia Society's 2014 position statement based on the Manchester Consensus Conference. Br J Sports Med. 2013; 48(14):1079-87. DOI: 10.1136/bjsports-2013-092872. View

Birmingham P, Kelly B, Jacobs R, McGrady L, Wang M . The effect of dynamic femoroacetabular impingement on pubic symphysis motion: a cadaveric study. Am J Sports Med. 2012; 40(5):1113-8. DOI: 10.1177/0363546512437723. View

Van Der Donckt K, Steenbrugge F, Van Den Abbeele K, Verdonk R, Verhelst M . Bassini's hernial repair and adductor longus tenotomy in the treatment of chronic groin pain in athletes. Acta Orthop Belg. 2003; 69(1):35-41. View

10.

Muschaweck U, Berger L . Minimal Repair technique of sportsmen's groin: an innovative open-suture repair to treat chronic inguinal pain. Hernia. 2010; 14(1):27-33. DOI: 10.1007/s10029-009-0614-y. View

11.

Namdari S, Scott K, Milby A, Baldwin K, Lee G . Athletic performance after ACL reconstruction in the Women's National Basketball Association. Phys Sportsmed. 2011; 39(1):36-41. DOI: 10.3810/psm.2011.02.1860. View

12.

Meyers W, Foley D, Garrett W, Lohnes J, Mandlebaum B . Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (Performing Athletes with Abdominal or Inguinal Neuromuscular Pain Study Group). Am J Sports Med. 2000; 28(1):2-8. DOI: 10.1177/03635465000280011501. View

13.

Kumar A, Doran J, Batt M, Nguyen-Van-Tam J, Beckingham I . Results of inguinal canal repair in athletes with sports hernia. J R Coll Surg Edinb. 2002; 47(3):561-5. View

14.

Khan W, Zoga A, Meyers W . Magnetic resonance imaging of athletic pubalgia and the sports hernia: current understanding and practice. Magn Reson Imaging Clin N Am. 2012; 21(1):97-110. DOI: 10.1016/j.mric.2012.09.008. View

15.

Hackney R . The sports hernia: a cause of chronic groin pain. Br J Sports Med. 1993; 27(1):58-62. PMC: 1332110. DOI: 10.1136/bjsm.27.1.58. View

16.

Farber A, Wilckens J . Sports hernia: diagnosis and therapeutic approach. J Am Acad Orthop Surg. 2007; 15(8):507-14. DOI: 10.5435/00124635-200708000-00007. View

17.

Susmallian S, Ezri T, Elis M, Warters R, Charuzi I, Muggia-Sullam M . Laparoscopic repair of "sportsman's hernia" in soccer players as treatment of chronic inguinal pain. Med Sci Monit. 2004; 10(2):CR52-4. View

18.

Steele P, Annear P, Grove J . Surgery for posterior inguinal wall deficiency in athletes. J Sci Med Sport. 2005; 7(4):415-21. DOI: 10.1016/s1440-2440(04)80257-3. View

19.

Namdari S, Baldwin K, Anakwenze O, Park M, Huffman G, Sennett B . Results and performance after microfracture in National Basketball Association athletes. Am J Sports Med. 2009; 37(5):943-8. DOI: 10.1177/0363546508330150. View

20.

Carey J, Huffman G, Parekh S, Sennett B . Outcomes of anterior cruciate ligament injuries to running backs and wide receivers in the National Football League. Am J Sports Med. 2006; 34(12):1911-7. DOI: 10.1177/0363546506290186. View