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Does bony hip morphology affect the outcome of treatment for patients with adductor-related groin pain? Outcome 10 years after baseline assessment
  1. Per Hölmich1,2,
  2. Kristian Thorborg1,
  3. Per Nyvold1,
  4. Jakob Klit2,
  5. Michael B Nielsen3,
  6. Anders Troelsen4
  1. 1Arthroscopic Center Amager, Copenhagen Sports Orthopaedic Research Center, Copenhagen University Hospital, Copenhagen, Denmark
  2. 2AspetarSports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  3. 3Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  4. 4Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre, University Hospital, Copenhagen, Denmark
  1. Correspondence to Dr P Hölmich, Arthroscopic Center Amager, Copenhagen Sports Orthopaedic Research Center, Copenhagen University Hospital, Italiensvej 1, DK-2300 Copenhagen S, Denmark; per.holmich{at}regionh.dk

Abstract

Background Adductor-related groin pain and bony morphology such as femoroacetabular impingement (FAI) or hip dysplasia can coexist clinically. A previous randomised controlled trial in which athletes with adductor-related groin pain underwent either passive treatment (PT) or active treatment (AT) showed good results in the AT group. The primary purpose of the present study was to evaluate if radiological signs of FAI or hip dysplasia seem to affect the clinical outcome, initially and at 8–12 years of follow-up.

Methods 47 patients (80%) were available for follow-up. The clinical result was assessed by a standardised clinical outcome combining patient-reported activity, symptoms and physical examination. Anterioposterior pelvic radiographs were obtained and the centre-edge angle of Wiberg, α angle, presence of a crossover sign and Tönnis grade of osteoarthritis were assessed by a blinded observer using a reliable protocol.

Results No significant between-group differences regarding the distribution of radiological morphologies were found. There was a decrease over time in clinical outcome in the AT group with α angles >55° compared to those with α angles <55° (p=0.047). In the AT group, there was no significant difference in the distribution of Tönnis grades between hips that had an unchanged or improved outcome compared with hips that had a worse outcome over time (p=0.145).

Conclusions No evidence was found that bony hip morphology related to FAI or dysplasia prevents successful outcome of the exercise treatment programme with results lasting 8–12 years. The entity of adductor-related groin pain in physically active adults can be treated with AT even in the presence of morphological changes to the hip joint.

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