Gilmore's Groin (Sportsman's Hernia) Management
Surgical repair is the definitive treatment for Gilmore's groin, with open suture repair techniques achieving 95-96% success rates in returning athletes to competitive sport, typically within 14-15 weeks. 1, 2
Clinical Recognition
Gilmore's groin (also called sportsman's hernia or athletic pubalgia) presents as chronic inguinal/pubic exertional pain in high-performance athletes, most commonly male soccer and ice hockey players, caused by rectus abdominal wall weakness or injury without a palpable hernia. 1, 3 The pathophysiology involves a circumscribed weakness in the posterior wall of the inguinal canal creating a localized bulge that compresses the genital branch of the genitofemoral nerve. 4
Diagnostic Approach
This is primarily a clinical diagnosis of exclusion based on history of chronic groin pain unresponsive to conservative treatment, with subtle physical examination findings. 3
Plain radiography, ultrasonography, and scintigraphy should be first-line investigations to supplement clinical assessment and rule out other pathology like osteitis pubis and musculotendinous injuries. 5
MRI or CT may be helpful in difficult cases to define anatomical extent of groin injury, though they cannot definitively rule out sportsman's hernia and their routine use cannot be justified due to cost. 5
Herniography may assist in cases of obscure chronic groin and pelvic pain. 5
Treatment Algorithm
Conservative Management
- Conservative treatment rarely results in symptom resolution and should not be prolonged in motivated athletes. 3
Surgical Intervention (Definitive Treatment)
The most appropriate surgical approach is unilateral or bilateral rectus reattachment (not traditional hernia repairs like Lichtenstein, Shouldice, Kugel, or laparoscopic approaches, which do not stabilize the pelvis and are less successful). 1
Specific Surgical Techniques:
Minimal Repair technique: An innovative open suture repair that addresses the circumscribed posterior wall weakness with elastic suture, abolishing nerve compression without enlarging the defect. 4
- No prosthetic mesh required
- Can be performed under local anesthesia
- Less traumatization with lower risk of severe complications
- Professional athletes return to training in 7 days (median) and full activity in 14 days (median)
- Complete pain relief achieved in average of 14 days 4
Traditional Gilmore repair: Repair of the posterior inguinal wall deficiency results in therapeutic benefit in selected cases. 5
Combined approach: Rectus reattachment may be performed with adductor release when adductor pain or weakness is present on physical examination. 1
Expected Outcomes
95-96% of motivated patients achieve pain-free return to competitive sports after surgical repair and physical rehabilitation. 1, 2
Return to competitive sport occurs within 15 weeks with traditional approaches 2, or as early as 14 days with the Minimal Repair technique in professional athletes. 4
Critical Pitfalls
Do not pursue prolonged conservative management in athletes with confirmed diagnosis, as it rarely succeeds and delays definitive treatment. 3
Avoid traditional hernia repair techniques (Lichtenstein, Shouldice, laparoscopic) as they fail to stabilize the pelvis and have inferior outcomes. 1
Must distinguish from osteitis pubis and musculotendinous injuries, which are more common causes of groin pain in athletes. 5
Early surgical intervention is key when conservative management has failed, though success is not universal. 5