Rectus Abdominis Repair Compared to Posterior Wall Mesh Reinforcement in Athletes With Sportsman's Hernia: A Systematic Review.

Athletic pubalgia is a relatively uncommon injury that is not fully understood. There are few high-level studies comparing treatments of athletic pubalgia, and this investigation seeks to utilize original articles to compare two common techniques for treatment of athletic pubalgia. The purpose of this study is to compare two prominent procedures, i.e., rectus abdominus repair and posterior wall reinforcement, through a systematic review. Inclusion/exclusion criteria were identified and then applied to search strategies in PubMed and MEDLINE. Two reviewers screened articles based on the agreed-upon criteria in a primary screen of titles and abstracts and a secondary screen of full-text articles. A total of 59 full-text articles were reviewed, and 13 were selected for this study. The study designs included seven prospective cohort studies, five retrospective cohort studies, and one randomized control trial. There were five studies with rectus abdominus repair intervention and eight studies with posterior wall reinforcement intervention. The median age range was 22-32. The mean follow-up time ranged from one month to 12.5 years. The success rate ranged from 76% to 96% for rectus abdominus repair and from 72% to 98% for posterior wall reinforcement. The two procedures performed about the same as the success rate for both procedures ranged from about 70% to 90%. The lack of standardization in clinical outcomes makes comparison across studies difficult. It is hard to discern which procedure actually performs better, and thus future research in this area needs to be conducted to focus on more specific outcomes, frequent follow-up, and standardization of outcome measures.