The Journal of Bone and Joint Surgery (American). 2007;89:2173-2178.
doi:10.2106/JBJS.F.00567
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Adductor-Related Groin Pain in Competitive Athletes

Role of Adductor Enthesis, Magnetic Resonance Imaging, and Entheseal Pubic Cleft Injections

Ernest Schilders, MD1, Quamar Bismil, MBChB Hons, MRCS2, Philip Robinson, FRCR3, Philip J. O'Connor, FRCR3, Wayne William Gibbon, FRCR4 and J. Charles Talbot, MBChB, MRCS5

1 Department of Orthopaedics, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, England. E-mail address: e.schilders{at}btopenworld.com
2 Apartment 62, Juniper Drive, Battersea Reach, London SW18 1TZ, England. E-mail address: quamar.bismil{at}btinternet.com
3 Department of Radiology, Leeds Teaching Hospitals Trust and Leeds University, Great George Street, Leeds LS1 3EX, England. E-mail address for P. Robinson: philrob66{at}hotmail.com. E-mail address for P.J. O'Connor: philipo{at}ulth.northy.nhs.uk
4 Departments of Radiology and Medical Imaging, University of Queensland, Brisbane QLD 4072, Australia. E-mail address: w.gibbon{at}mailbox.uq.edu.au
5 Yorkshire Deanery, Aisling House, Albion Street, Clifford, West Yorkshire LS23 6HY, England. E-mail address: charlietalbot{at}doctors.org.uk

Investigation performed at Bradford Royal Infirmary, Bradford, England

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Adductor dysfunction is a condition that can cause groin pain in competitive athletes, but the source of the pain has not been established and no specific interventions have been evaluated. We previously defined a magnetic resonance imaging protocol to visualize adductor enthesopathy. The aim of this study was to elucidate, in the context of adductor-related groin pain in the competitive athlete, the role of the adductor enthesis (origin), the relevance of adductor enthesopathy diagnosed with magnetic resonance imaging, and the efficacy of entheseal pubic cleft injections of local anesthetic and steroids.

Methods: We reviewed the findings in a consecutive series of twenty-four competitive athletes who had presented to our sports medicine clinic with groin pain secondary to adductor longus dysfunction. Magnetic resonance imaging was performed to assess the adductor longus origin for the presence or absence of enthesopathy. Seven patients (Group 1) had no evidence of enthesopathy on magnetic resonance imaging, and seventeen patients (Group 2) had enthesopathy confirmed on magnetic resonance imaging. All patients were treated with a single pubic cleft injection of local anesthetic and steroid into the adductor enthesis. At one year after this treatment, the patients were assessed for recurrence of symptoms.

Results: On clinical reassessment five minutes after the injection, all twenty-four athletes reported resolution of the groin pain. At one year, none of the seven patients in Group 1 had experienced a recurrence. Sixteen of the seventeen patients in Group 2 had a recurrence of the symptoms (p < 0.001) at a mean of five weeks (range, one to sixteen weeks) after the injection.

Conclusions: A single entheseal pubic cleft injection can be expected to afford at least one year of relief of adductor-related groin pain in a competitive athlete with normal findings on a magnetic resonance imaging scan; however, it should be employed only as a diagnostic test or short-term treatment for a competitive athlete with evidence of enthesopathy on magnetic resonance imaging.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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Letters to the Editor:

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Adductor-Related Groin Pain
Ziad Harb, et al.
JBJS Online, 1 May 2008 [Full text]
Dr. Bismil et al. respond to Dr. Harb
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