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Edelman Hybrid mesh for sports hernia repair

of the activity causes the pain to recur. Athletes will was published demonstrating excellent results. The
[8]
commonly describe that pain occurs while running ideal material, mesh or suture, for hernia repair should
and then attempting to move quickly in an opposite be inexpensive to produce, easy to use, promote host
direction. They may find it difficult to go from a tissue ingrowth, result in a healed repair with equal
stationary position and initiate a running motion. strength to normal tissue over extended periods of
time, provide resistance to infection, elicit little or
The physical exam is frequently not helpful in the no inflammatory response and inhibit adhesion or
work up of groin pain, but certain subtle findings on fistula formation. Surgisis was initially used as a graft
the exam of an injured athlete are important. Adductor material for arteries, veins, ligaments, dura, urinary
tightness and pain at the inferior pubic insertion is bladders and wound coverage. It has also been
not uncommon when the adductor longus tendon shown to be effective in the repair of abdominal wall
is involved in the injury. Rectus abdominis injury hernias. Biologic mesh, like porcine submucosa, acts
can elicit tenderness on the anterior pubic bone but as a scaffold for host tissue collagen to re-populate
generalized osteitis pubis will also cause tenderness the injured area with excellent revascularization. [10]
to palpation in that area. With the athlete standing, However, over time, there has been a question of the
palpation of the posterior pubic area and posterior long term durability and strength with biologic mesh. [4]
inguinal floor can find cause pain or alternatively, a Hybrid mesh was released in 2014 to meet the unmet
laxity of the posterior inguinal floor is appreciated. need of a predecessor mesh for optimizing hernia
I will have the athlete lay supine on my exam table repair. By adding a very lightweight polypropylene
while placing my index finger into the external ring mesh to a few layers of a biologic collagen matrix, it
while having the athlete do a bilateral straight leg is hoped that a beneficial host response will result in
raise while their arms are lifted to the ceiling. I find an optimal repair. [11] This initial study on a select group
that the same laxity or pain in the inguinal floor is of patients suggests the benefits are excellent and
a reproducible physical finding on patients with a supports continued investigation into the use of hybrid
“sports hernia”. mesh for abdominal wall repair and re-inforcement.

An ultrasound can demonstrate a classic inguinal Financial support and sponsorship
hernia and is an adequate study to go forward with Nil.
surgical treatment. An MRI is commonly obtained to
look at the pelvis and hip for musculo-skeletal injuries Conflicts of interest
that might benefit from orthopedic consultation. There are no conflicts of interest.

Sports hernia can be managed either non-operatively Patient consent
or operatively. Non-operative management consists
of a combination of rest, NSAIDs, corticosteroid All involved patients gave their consent forms.
injections or platelet derived plasma injections, all
followed by physical therapy. Athletes can return to Ethics approval
sports in 3-4 weeks if they are pain free. However, if IRB/Ethics review was not needed by my institution to
after 6-12 weeks they are not pain-free, repeat MRI review this data.
and operative intervention should be considered.
REFERENCES
The operative management of sports hernias involve
the re-inforcement of the posterior abdominal wall 1. Gilmore OJA. Gilmore’s groin: ten years experience of groin
using suture as described by Meyers et al. or disruption - a previously unsolved problem in sportsmen. Sports Med
[5]
Minnich et al., which consists of modifications of 2. Soft Tissue Trauma 1991;3:12-4.
[6]
Malycha P, Lovell G. Inguinal surgery in athletes with chronic groin
the classic Bassini hernia repair. Alternatively, a pain: the ‘sportsman’s’ hernia. Aust NZ J Surg 1992;62:123-5.
laparoscopic repair as described by Paajanen et al. [7] 3. Ansaloni L, Catena F, Coccolini F, Gazzotti F, D’Alessandro L, Pinna
or Edelman and Selesnick involves mesh placed AD. Inguinal hernia repair with porcine smallintestine submucosa: 3
[8]
behind the inguinal floor in the pre-peritoneal space. year follow-up results of a randomized control trial of Lichtenstein’s
Mesh is commonly used in the laparoscopic repair of repair with polypropylene mesh versus Surgisis Inguinal Hernia
inguinal hernias and sports hernias. Fixing the mesh Matrix. Am J Surg 2009;198:303-12.
[9]
with absorbable tacks or fibrin sealant is encouraged. 4. Jin J, Rosen MJ, Blatnik J, McGee MF, Williams CP, Marks J, Ponsky
J. Use of acellular dermal matrix for complicated ventral hernia repair:
Presently, polypropylene is the most commonly used does technique affect outcomes? J Am Coll Surg 2007;205:654-60.
prosthetic. In 2006, the laparoscopic treatment of 5. Meyers WC, McKechnie A, Philippon MJ, Horner MA, Zoga AC,
sports hernia using porcine submucosa, biologic mesh Devon ON. Experience with “sports hernia” spanning two decades.
Mini-invasive Surgery ¦ Volume 1 ¦ March 31, 2017 33