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Athletic groin pain: a systematic review of surgical diagnosis, investigations, and treatments

Groin pain in both the recreational and elite athlete can be challenging to evaluate and treat, especially in the primary care setting. This systematic review was done to uncover the most prevalent surgical aetiologies, characterize the susceptible patient profiles, and discuss treatment. This review involved 73 studies (4655 patients) from North America, Asia, Europe and Australia. The age range was from 13-48 yo, with the average age being 27.4 years old.

The objective of this article is to discuss the top 5 aetiologies of hip/groin pain  (> 80% of presentations) in the young active population to aid in the diagnosis by primary care physicians with subsequent referral to orthopaedic surgery.

There is equal distribution between intra-articular and extra-articular causes of groin pain.


The most common ethology is Femoral Acetabular impingement, FAI – (32%). 58% are males and the most common sports associated with FAI are ice hockey and soccer. The incidence of a labral tear associated with FAI is 35%. Tests used to diagnosis include palpation and FADIR testing (ant. impingement test). MRI is the most common imaging used to diagnose groin pain (40%). Intra-Articular causes (FAI and labrum) are almost exclusively treated with laparoscopic chondrolabral debridement and repair. Labral tears are the 5th most common cause of groin pain with a prevalence of 5% in this population. It is most commonly seen in hockey, soccer, rowing and tae kwon do. MRI arthrogram and/or 3T MRI should be used to aid in this diagnosis.


The second most common cause of groin pain is athletic pubalgia (sports hernia). Athletic pubalgia (24%) is followed by Adductor related pathology (12%) and inguinal related pathology (10%). All three of these conditions are seen almost exclusively in men (>98%). There was no correlation of the athletic level of the athlete. Soccer is the most common cause of all three of above pathologies, followed by football and hockey. According to this review, the most common (>70%) surgical intervention for athletic pubalgia is open or arthroscopic repair with mesh reinforcement. 70% of adductor related pathology is treated with complete adductor tenotomy and 1% with reattachment. Inguinal hernia related pathology is evenly split between open and laparoscopic repair.

Overall it is recommended that a consistent physical exam and imaging approach should be determined to diagnosis athletic groin pain, which should consist of, but not limited to, gross palpation, FADIR, FABER, MRI and plain radiograph.

Of note, in patients where both intra and extra-articular pathology is present, superior outcomes are seen when both are surgically addressed at the same time.


Darren de SA, Per Holmich, Mark Phillips, Sebastian Heaven, Nicole Simunovic. British Journal of Sport Medicine, Oct 3, 2016

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