Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis

Abstract

Background: Hip and groin injuries are common in many sports. Understanding the factors differentiating athletes with hip/groin pain from those without these injuries could facilitate management and prevention.

Objective: Conduct a systematic review and meta-analysis of the literature on factors differentiating athletes with and without hip/groin pain.

Methods: The review was registered as PROSPERO CRD42014007416 and a comprehensive, systematic search was conducted in June 2014. Inclusion criteria were: cross-sectional, cohort or case-control study designs of n>10 that examined outcome measures differentiating athletes with and without hip/groin pain. Two authors independently screened search results, assessed study quality, and performed data extraction. Methodological heterogeneity was determined and data pooled for meta-analysis when appropriate. A best evidence synthesis was performed on the remaining outcome measures.

Results: Of 2251 titles identified, 17 articles were included of which 10 were high quality. Sixty two different outcome measures were examined, 8 underwent meta-analysis. Pooled data showed strong evidence that athletes with hip/groin pain demonstrated: pain and lower strength on the adductor squeeze test, reduced range of motion in hip internal rotation and bent knee fall out; however, hip external rotation range was equivalent to controls. Strong evidence was found that lower patient-reported outcome (PRO) scores, altered trunk muscle function, and moderate evidence of bone oedema and secondary cleft sign were associated with hip/groin pain.

Conclusions: PROs, pain and reduced strength on the adductor squeeze test, reduced range of motion in internal rotation and bent knee fall out are the outcome measures that best differentiate athletes with hip/groin pain from those without this pain.

Keywords: Athlete; Groin; Hip; Injuries; Sports.

Figure 1

Flow diagram for search results and study selection.

Figure 2

Forest plot demonstrating the odds ratio of pain with the adductor squeeze test.

Figure 3

Forest plot: association between hip/groin pain and hip internal rotation range of motion measured with neutral flexion/extension.

Figure 4

Forest plot: association between hip/groin pain and hip internal rotation range of motion measured with 90° hip and knee flexion.

Figure 5

Forest plot: association between hip/groin pain and hip external rotation range of motion measured with neutral flexion/extension.

Figure 6

Forest plot: association between hip/groin pain and bent knee fall out range of motion.

Figure 7

Forest plot: association between hip/groin pain and strength score for the adductor squeeze test.

Figure 8

Forest plot: association between hip/groin pain and presence of bone oedema on MRI.

Figure 9

Forest plot: association between hip/groin pain and presence of bone oedema on MRI following sensitivity analysis.

Figure 10

Forest plot: association between hip/groin pain and presence of secondary cleft sign.