The Doha agreement previously categorized various types of groin pain in athletes (adductor-, iliopsoas-, pubic-, hip-related, etc.) but did not provide a specific treatment algorithm to accompany this classification scheme. Īs our knowledge of CMI continues to evolve, there is a need to standardize the work-up and treatment of these injuries based on the symptomatic pathologies involved in each individual patient. Because core muscle injuries may include both orthopaedic and general surgical pathologies, it is necessary to treat a CMI through a team approach, with a sports medicine-trained orthopaedic surgeon, general surgeon and experienced radiologist involved throughout the care of these patients. Furthermore, although not directly related, additional pathologies have been found to be associated with CMI, including femoroacetabular impingement (FAI) and osteitis pubis (OP). CMI may include multiple pathologies such as rectus abdominis (RA) tendinopathy, adductor contracture or an inguinal hernia. As a result of the ambiguity in its definition, there is no current consensus on the terminology, appropriate diagnostic work-up or surgical treatment for core muscle injuries. In doing so, we aim to clarify the various pathologies involved in CMI, eliminate vague terminology, and present a clear, stepwise approach for both diagnosis and treatment of these injuries.Ĭore muscle injury (CMI), otherwise known as athletic pubalgia (AP), sports hernia or inguinal disruption, represents any of a number of musculotendinous injuries in the peripubic region affecting the structures which insert on the pubis. The purpose of this review is to present a detailed treatment algorithm for physicians treating patients with signs and symptoms of a CMI. Despite our increased knowledge of these injuries, there is still no universal terminology, diagnostic methodology or treatment for a CMI. Treatment of these injuries has been performed by both orthopaedic and general surgeons and may include a variety of procedures such as rectus abdominis repair, adductor lengthening, abdominal wall repair with or without mesh, and hip arthroscopy for the treatment of concomitant femoroacetabular impingement. These injuries have been associated with various terminologies including sports hernia, core muscle injury (CMI), athletic pubalgia and inguinal disruption, among others. In recent years, there has been increased awareness and treatment of groin injuries in athletes.
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