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Advancing hip and groin injury management: from eminence to evidence
  1. Kristian Thorborg1,2,
  2. Per Hölmich1,3
  1. 1 Arthroscopic Centre Amager, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
  2. 2 Physical Medicine & Rehabilitation Research—Copenhagen (PMR-C), and Departments of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Copenhagen, Denmark
  3. 3 ASPETAR Sports Groin Pain Center, Qatar Orthopedic and Sports Medicine Hospital, Doha, Qatar
  1. Correspondence to Kristian Thorborg, Arthroscopic Centre Amager, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark Italiensvej 1, 2300 Copenhagen S, Denmark;kristianthorborg{at}

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Hip and groin injuries include multiple, complex and long-standing conditions.1–3 Many treatment approaches and techniques, primarily investigated in case series (Level-4 evidence)4 for athletes with long-standing hip and groin injury, have continuously emerged and resurfaced during the last 30 years.5–9 These case series often claim to have a treatment success close to 100%, and to initiate a fast return to sport.10–15 These successful return rates, however, seldom match athletes and sports practitioners’ own experience as long-standing hip and groin injuries are often extremely difficult to recover from.1–3 ,16 ,17

Nothing ruins good results as valid follow-up!

The lack of reliable, valid and responsive outcome measures for patients with hip and groin injuries has, in our opinion, been one of the main reasons why very few treatment advances have been made within this field.5–9 ,18 ,19 While some existing treatments (based on case series) may have promise, their success has mostly been evaluated by treatment providers (often the operating surgeon and main author), instead of being evaluated by the treatment receivers (the patients). This makes it very difficult to get a true impression of these procedures’ potential effect. It is possible that patients’ perceptions of the treatment success of these interventions are entirely different from those of the treatment providers.20

However, with the recent development of reliable, valid and responsive outcome scores, such as the Copenhagen Hip And Groin Outcome Score,19 ,21 it is now possible to objectively evaluate patient-reported hip and groin symptoms and function.19 Furthermore, the development of reliable clinical tests, including hip strength, squeeze tests22–26 and specific hip range of motion tests,22 ,27 makes it possible to measure  some of the clinical impairments frequently presenting in this patient group.22 ,27–30 Further research into specific strength testing positions …

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  • Contributors KT and PH are the only authors and contributors. KT drafted the manuscript and both revised it.

  • Funding This work was funded by the Arthroscopic Centre Amager, Copenhagen University Hospital, Hvidovre, Copenhagen.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

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