Narrative Review and Clinical Recommendations for Sportsman's Hernia and Athletic Pubalgia Based on 30 Years of Expert Experience.

Purpose: Sportsman's Hernia and Athletic Pubalgia (SH/AP) typically develop as a result of muscle imbalance and continuous sports-related microtrauma to the groin area. The injury progresses through two phases: initially, SH is localized in the groin soft tissues, while in the advanced stage, AP extends the injury to the pubic bone. Despite increasing clinical recognition of SH/AP, high-quality, large-scale studies remain limited. As a result, extensive clinical experience may help inform understanding and managing the different phases of the injury. This narrative review aims to stream the authors' expertise-based on approximately 30 years of hands-on experience in diagnosing, treating, and endoscopically managing SH/AP-into a scientific literature and real-world clinical practice. Methods: An extensive literature review was conducted to present the current knowledge of diagnostic tests, imaging, endoscopic surgery and rehabilitation treatment of SH/AP. Where appropriate, clinical observations drawn from over three decades of surgical experience with SH/AP patients are used to contextualize the evidence. Results: MRI is a primary imaging tool for suspected SH/AP, particularly in advanced cases or when nerve involvement is suspected but multiple imaging findings may also be present in asymptomatic athletes. Clinical history and physical examination remain crucial in making the diagnosis of SH/AP, guiding imaging decisions as auxiliary test. Surgical treatment of SH/AP is may be indicated after 2-3 months of failed conservative treatment. The totally extraperitoneal (TEP) without or with release of inguinal ligament (TEP-RRT) approaches have been described in the literature with favorable outcomes. Postoperative rehabilitation plays a critical role in functional recovery. Conclusion: Physical examination and endoscopic surgery remain most effective in SH/AP according literature and authors experience, followed by dedicated controlled athletics muscles rehabilitation program.