Does bony hip morphology affect the outcome of treatment for patients with adductor-related groin pain? Outcome 10 years after baseline assessment

TY - JOUR

T1 - Does bony hip morphology affect the outcome of treatment for patients with adductor-related groin pain?

T2 - Outcome 10 years after baseline assessment

AU - Hölmich, Per

AU - Thorborg, Kristian

AU - Nyvold, Per

AU - Klit, Jakob

AU - Nielsen, Michael B

AU - Troelsen, Anders

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2014/8

Y1 - 2014/8

N2 - 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 tandardised 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 adductorrelated groin pain in physically active adults can be treated with AT even in the presence of morphological changes to the hip joint.

AB - 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 tandardised 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 adductorrelated groin pain in physically active adults can be treated with AT even in the presence of morphological changes to the hip joint.

KW - Abdominal Pain

KW - Adult

KW - Exercise Therapy

KW - Femoracetabular Impingement

KW - Follow-Up Studies

KW - Groin

KW - Hip Dislocation

KW - Humans

KW - Middle Aged

KW - Sports Medicine

KW - Treatment Outcome

U2 - 10.1136/bjsports-2013-092478

DO - 10.1136/bjsports-2013-092478

M3 - Journal article

C2 - 23847009

SN - 0306-3674

VL - 48

SP - 1240

EP - 1244

JO - British Journal of Sports Medicine

JF - British Journal of Sports Medicine

IS - 16

ER -