Sportsmans Groin: The Inguinal Ligament and the Lloyd Technique

Abstract

Groin pain is a catch all phrase used to define a common set of symptoms that affect many individuals. It is a common condition affecting sportsmen and women (1, 2) and is often referred to as the sportsman groin (SG). Multiple surgical operations have been developed to treat these symptoms yet no definitive imaging modalities exist to diagnose or predict prognosis. This article aims to discuss the anatomy of the groin, suggest a biomechanical pathophysiology and outline a logical surgical solution to treat the underlying pathology. A systematic clinical and imaging approach with inguinal ligament and pubic specific MRI assessment, can result in accurate selection for intervention. Close correlation with clinical examination and imaging in series is recommended to avoid misinterpretation of chronic changes in athletes.

Keywords: Groin pain; Inguinal Ligament; Lloyd release; MRI; Surgery.

Figure 1

Structures attached to the pubic tubercle.

Figure 2

Vectors on the pubis as a clock-face.

Figure 3

a) 30 year old footballer with left groin pain. Coronal oblique high resolution image through the medial aspect of the inguinal ligament adjacent to the pubic enthesis demonstrates a cord-like medial aspect of the inguinal ligament (red arrow). b) 30 year old footballer with left groin pain. Angled oblique axial inlet High resolution T2 fat suppressed images through the superior aspect of the pubic bone at the site of the inguinal ligament insertion demonstrates BMO of the left pubic bone (red arrowhead) c) 30 year old footballer with left groin pain. Coronal oblique High resolution T2 fat suppressed images through the adductor insertion on the right and pubic tubercle on the left, demonstrates site specific BMO of the left pubic bone at the inguinal entheses (long red arrow) and a right adductor cleft with associated site specific BMO (short red arrow).