A case for the laparoscopic approach for rectus-adductor tendonopathy-athletic pubalgia

Abstract

Athletes with athletic pubalgia from core muscle injuries have many options available for treatment. Magnetic resonance imaging (MRI) can show pubic bone edema, rectus muscle insertion atrophy, and/or adductor tendonopathy. Our surgical repair using laparoscopically placed biologic mesh placed posteriorly with an open mini-incision to the anterior adductor longus tendon has had excellent results. This presentation will review the injury, a failed open repair followed by a biologic repair involving the rectus-adductor tendon injury onto the pubic bone of a recently treated athlete. A 28-year-old professional athlete presented 4 weeks after an open core muscle injury (CMI) repair. MRI showed disruption of the adductor tendon from the pubis and persistent opposing side rectus abdominis muscle insertion atrophy. After rehabilitation, his complete recovery prompted a retrospective review of all patients with laparoscopic biologic mesh. The laparoscopic, posterior, preperitoneal repair of the rectus-adductor tendon with biologic mesh is effective in treating athletes with athletic pubalgia. The laparoscopic approach to a rectus-adductor tendon injury using biologic mesh has not been well defined. A postoperative MRI found complete regeneration of the rectus and adductor muscles after a failed open CMI surgery (Meyer Repair). The peri-operative MRI shows the surgical progression of this condition.