"Sports" hernia: treatment with biologic mesh (Surgisis): a preliminary study.

BACKGROUND: Groin pain in athletes is caused by a wide range of musculoskeletal disorders. Occasionally, a palpable bulge at the external ring or ultrasound may not demonstrate a hernia. When athletes do not respond to conservative treatment, a "sports" hernia should be considered. METHODS: A retrospective review of 750 laparoscopic preperitoneal hernias was performed. A sports hernia was defined as a tear in the transversalis fascia that was not evident by preoperative physical exam. A 7 x 10-cm biologic mesh, Surgisis, was placed, uncut, over the myopectinate orifice and fixed with five tacks or fibrin glue. Patients were followed up at 2 and 6 weeks, 6 months, and 1 year. RESULTS: Ten professional and amateur athletes were found to have sports hernias. Operative time averaged 32 min. There were no major complications. All athletes returned to full activities in 4 weeks. Only one patient did not show improvement in his symptoms. No patient developed a recurrent hernia. CONCLUSIONS: Laparoscopic exploration should be considered in athletes with chronic groin pain that does not improve after conventional treatments have failed. Furthermore, biologic mesh (Surgisis) should be considered for the repair of inguinal sports hernias.

A waterproof cast liner earns high marks.

Nondisplaced and stable fractures or severe sprains may be casted using fiberglass and a waterproof liner. Application of the liner is illustrated and described here. Allergic reactions, liner bulkiness, cast application and removal, and cost of materials have not proven to be problems. Among 337 patients fitted with this liner, odor, itching, and difficulties with drying were minimal, even though patients swam, bathed, or received hydrotherapy. Minor skin complications occurred in 5.9% of patients. Physician and patient satisfaction with the liner was high.

Back injuries in basketball players.

The basketball player with lower back or lower extremity radicular pain needs to be carefully evaluated. A complete history of any previous symptomatology and a specific history of the new injury are absolutely essential. A careful physical examination with an understanding of the anatomy as well as possible causes of the lower back pain is crucial. An accurate diagnosis is essential in treating every athlete. Most basketball-related lower back injuries will respond to conservative nonsurgical treatment. Rehabilitation is a cornerstone in not only treating the initial symptoms, but decreasing the risks of reinjury. The goal of returning the basketball player to previous performance level as quickly as possible, with a minimal risk of re-injury, is the goal of the team physicians.

Iliotibial band friction syndrome: MR imaging findings.

Six patients with clinical histories and physical examination results consistent with iliotibial band friction syndrome (ITBFS) were examined with magnetic resonance (MR) imaging. Ill-defined decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images was present deep to the iliotibial band, adjacent to the lateral femoral epicondyle. Axial fast imaging with steady-state precession (FISP) gradient-echo sequences were essential in differentiating the ill-defined signal intensity abnormality associated with ITBFS from fluid in the lateral knee joint. None of these patients were found to have lateral meniscal tears, and all responded to conservative measures directed at treating ITBFS. The authors conclude that MR imaging may be useful in confirming or establishing the diagnosis of ITBFS in patients with the appropriate clinical history and distal lateral thigh or lateral knee pain.

Unusual Tibial Stress Fracture in a Basketball Player.

In brief Stress fractures of the proximal middle third of the tibia are common; those of the distal tibia are less common; and longitudinal stress fractures are rare. The basketball player in this case report had a rare longitudinal tibial pilon stress fracture, for which few diagnostic or treatment guidelines existed.