Article Text

Download PDFPDF

Long-standing groin pain in contact sports: a prospective case–control and MRI study
  1. Hannu Paajanen1,
  2. Heikki Hermunen2,
  3. Leena Ristolainen3,
  4. Sonia Branci4,5
  1. 1 Department of Surgery, University of Eastern Finland, Kuopio, Finland
  2. 2 Department of Radiology, Mikkeli Central Hospital, Mikkeli, Finland
  3. 3 Department of Orthopaedics, Orton Orthopaedic Hospital, Helsinki, Finland
  4. 4 Department of Radiology, Rigshospitalet, Copenhagen, Denmark
  5. 5 Arthroscopic Center Amager, Hvidovre Hospital, Copenhagen, Denmark
  1. Correspondence to Dr Hannu Paajanen; paajanen{at}


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

  • groin
  • injuries
  • MRI

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from


  • Contributors HP was responsible for the conception and design of the study, recruitment of participants, data collection and drafting. HH and SB contributed to interpretation of the radiological findings and had full access to all data. LR contributed to interpretation of the data and revision of the manuscript. The final manuscript was approved by all authors.

  • Funding This trial was financially supported by the Competitive State Research Financing of the Expert Responsibility Area of Kuopio University Hospital. Financial support was also received from Orton Orthopaedic Hospital, Helsinki, Finland (the Ministry of Social Affairs and Health grant, 9310/478).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.