Long-standing groin pain in contact sports: a prospective case-control and MRI study

Abstract

Objectives: We aimed to prospectively evaluate the prevalence of long-standing groin pain and related MRI findings in contact sports.

Methods: This case-control study followed three male elite-level soccer, ice-hockey and bandy teams (102 players) for 2 years. All athletes with long-standing groin pain lasting >30 days and age-matched controls (1:3) from the same teams were examined clinically, using pelvic MRI and Hip and Groin Outcome Scores (HAGOS). Primary outcome measures were annual prevalence of groin pain and underlying MRI findings.

Results: The annual prevalence of chronic groin pain was 7.5%. Training characteristics and pain scores of athletes were similar in all teams. On MRI, there was no significant difference in the percentage of pubic bone marrow oedema (p = 0.80) between symptomatic players (8/15; 53%) versus controls (20/43; 47%), but adductor tendinopathy and degenerative changes at the pubic symphysis were twice more common among players with pain. Rectus muscle or iliopsoas pathology were seldom observed. Lower HAGOS subscales (p < 0.01) were recorded in players who experienced groin pain compared with the controls.

Conclusion: Long-standing groin pain was observed annually in 1 of 14 athletes in contact sports. Abnormalities in the pubic symphysis were common MRI findings in both symptomatic and asymptomatic players.

Trial registration number: NCT02560480.

Keywords: MRI; groin; injuries.

Figure 1

Flow diagram of the study. HAGOS, Hip and Groin Outcome Scores.

Figure 2

Pubic bone marrow oedema in MRI was graded as 0 (no oedema), I (mild, <1 cm), II (moderate, 1–2 cm) or III (heavy,>2 cm).

Figure 3

An MRI (STIR sequence) of symptomatic soccer player groin. Grade III bone marrow oedema (arrow) is demonstrated in the left pubic symphysis with an adductor longus injury (bright signal below pubic bone).