The Journal of Bone and Joint Surgery (American). 2009;91:2455-2460.
doi:10.2106/JBJS.H.01675
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Adductor-Related Groin Pain in Recreational Athletes

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

Ernest Schilders, MD1, J. Charles Talbot, MBChB, MRCS, MSc(Eng)1, Philip Robinson, MBChB, MRCP, FRCR2, Alexandra Dimitrakopoulou, MD1, Wayne William Gibbon, FRCR3 and Quamar Bismil, MBChB(Hons), MRCS, DipSEM, MFSEM, FRCS(Tr&Orth)1

1 Department of Orthopaedics, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, England. E-mail address for E. Schilders: e.schilders{at}btopenworld.com. E-mail address for J.C. Talbot: charlietalbot{at}doctors.org.uk. E-mail address for A. Dimitrakopoulou: alexdimitr{at}yahoo.gr. E-mail address for Q. Bismil: quamar.bismil{at}btinternet.com
2 Department of Radiology, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds LS7 4SA, England. E-mail address: p.robinson{at}leedsth.nhs.uk
3 Department of Medical Imaging, University of Queensland, Brisbane QLD 4072, Australia. E-mail address: w.gibbon{at}mailbox.uq.edu.au

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.

Background: Adductor dysfunction can cause groin pain in athletes and may emanate from the adductor enthesis. Adductor enthesopathy may be visualized with magnetic resonance imaging and may be treated with entheseal pubic cleft injections. We have previously reported that pubic cleft injections can provide predictable pain relief at one year in competitive athletes who have no evidence of enthesopathy on magnetic resonance imaging and immediate relief only in patients with findings of enthesopathy on magnetic resonance imaging. In this follow-up study, we attempted to determine if the same holds true for recreational athletes.

Methods: We reviewed a consecutive case series of twenty-eight recreational athletes who had presented to our sports medicine clinic with groin pain secondary to adductor longus dysfunction. A period of conservative treatment had failed for all of these athletes. The adductor longus origin was assessed with magnetic resonance imaging for the presence or absence of enthesopathy. All patients were treated with a single pubic cleft injection of a local anesthetic and corticosteroid into the adductor enthesis. The patients were assessed for recurrence of symptoms at one year after treatment.

Results: On clinical reassessment five minutes after the injection, all twenty-eight athletes reported resolution of the groin pain. Fifteen patients (Group 1) had no evidence of enthesopathy on magnetic resonance imaging, and thirteen patients (Group 2) had findings of enthesopathy on magnetic resonance imaging. At one year after the injection, five of the fifteen patients in Group 1 had experienced a recurrence; these recurrences were noted at a mean of fourteen weeks (range, seven to twenty weeks) after the injection. Four of the thirteen patients in Group 2 had experienced a recurrence of the symptoms at one year, and these recurrences were noted at a mean of eight weeks (range, two to nineteen weeks) after the injection. Overall, nineteen (68%) of the twenty-eight athletes had a good result following the injection. Of the remaining nine athletes, two were treated successfully with repeat injection; therefore, overall, twenty-one (75%) of the twenty-eight athletes had a good result after entheseal pubic cleft injection.

Conclusions: Most recreational athletes with adductor enthesopathy have pain relief at one year after entheseal pubic cleft injection, regardless of the findings on magnetic resonance imaging. There were similarities between this group of recreational athletes and the competitive athletes in our previous study, in that the adductor enthesis was the source of pain and entheseal pubic cleft injection was a valuable treatment option. The main difference was that, in this group of recreational athletes, magnetic resonance imaging evidence of adductor enthesopathy did not correlate with the outcome of the injection.

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


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