Hip and Groin Injuries in Athletes

Abstract

Although athletic injuries about the hip and groin occur less commonly than injuries in the extremities, they can result in extensive rehabilitation time. Thus, an accurate diagnosis and well-organized treatment plan are critical. Because loads of up to eight times body weight have been demonstrated in the hip joint during jogging, presumably even greater loads can occur during vigorous athletic competition. The available imaging modalities are effective diagnostic tools when selected on the basis of a thorough history and physical examination. Considerable controversy exists as to the cause and optimal treatment of groin pain in athletes, or the so-called "sports hernia." There has also been significant recent attention focused on intraarticular lesions that may be amenable to hip arthroscopy. This article briefly reviews several common hip and groin conditions affecting athletic patients and highlights some newer topics.

Proposed Algorithm for the Management of Athletes With Athletic Pubalgia (Sports Hernia): A Case Series

“…5,58 Open repair of a sports hernia involves reattaching the rectus abdominis, conjoined tendon, and/or transversalis fascia to the pubis and inguinal ligaments, and is often reinforced with a polypropylene mesh. 40,48,50,53,58,63 If there is preoperative involvement of the adductor longus tendon, the surgeon may opt to concurrently perform an adductor tenotomy-typically fractional lengthening.…”

“…40,48,50,53,58,63 If there is preoperative involvement of the adductor longus tendon, the surgeon may opt to concurrently perform an adductor tenotomy-typically fractional lengthening. 1,2,5,50,53,58,80 The increasingly common laparoscopic procedure involves preperitoneal insertion of a polypropylene mesh, 1,22,39,46,63,74,80 resulting in less postoperative pain, smaller incisions, faster recovery rate, and has the additional advantage in that a diagnostic scope can be immediately followed by the repair. 46,61,80 Early outcome studies utilizing laparoscopic repair indicate high success in rates of return to preinjury level of play within 3 to 6 months.…”

“…1,40,61 The differential diagnosis of groin pain is challenging, based on the significant symptom overlap among various groin pathologies and the fact that multiple dysfunctions often coexist. 5,37,62,66,80 A recent published case report outlines the differential diagnosis of a sports hernia. 79 Many diagnoses (snapping hip syndrome, hip subluxation/dislocation, acetabular labral tears, and bursitis) were immediately ruled out due to the absence of various signs and symptoms.…”

“…79 Many diagnoses (snapping hip syndrome, hip subluxation/dislocation, acetabular labral tears, and bursitis) were immediately ruled out due to the absence of various signs and symptoms. 5,59,62,63 Others were omitted based on a negative radiograph or MRI report (avulsion fracture, proximal hip fracture, stress fracture) 5,51,53,[61][62][63]73 or based on the absence of neurological signs and symptoms (lumbar radiculopathy, pudendal/genitofemoral neuropathy, obturator nerve entrapment, ilioinguinal neuralgia). 5,51,62,63,73 Inguinal hernia was ruled out, as there was no palpable hernia.…”

“…5,59,62,63 Others were omitted based on a negative radiograph or MRI report (avulsion fracture, proximal hip fracture, stress fracture) 5,51,53,[61][62][63]73 or based on the absence of neurological signs and symptoms (lumbar radiculopathy, pudendal/genitofemoral neuropathy, obturator nerve entrapment, ilioinguinal neuralgia). 5,51,62,63,73 Inguinal hernia was ruled out, as there was no palpable hernia. Other diagnoses (rectus femoris strain, symphyseal instability) 5,52 might have been concomitantly present in some of the athletes, but the investigators believed they were chronic secondary dysfunctions.…”