title: Athletic groin pain: a systematic review and meta-analysis of surgical versus physical therapy rehabilitation outcomes.
abstract: BACKGROUND
  Athletic groin pain (AGP) is an encompassing term for the multitude of chronic conditions presenting as pain in the inguinal region. The purpose of this review was to compare the return to play rates (RTPrate) and return to play times (RTPtime) between surgical and rehabilitation interventions in the treatment of AGP.
  
  
  METHODS
  A systematic review of English language peer review journals was carried out between 1980 to June 2013 using PubMed, Embase, CINHAL and Google Scholar searching for all papers relating to AGP (and its various pseudonyms) and all surgical and rehabilitative interventions which reported RTPrate and/or RTPtime. AGP literature has been subdivided by many eponymous diagnoses but anatomical diagnostic groupings of (1) abdominal wall, (2) adductor and (3) pubic related pain were used in this review. Meta-analysis was then carried out on the data to compare results between the surgical and rehabilitation groups.
  
  
  RESULTS
  Fifty-six papers out of the 561 discovered in the initial search were included in the review with 3332 athletes included. Evidence was mostly level IV. Using the Black and Downs checklist we found poor study quality overall with a high risk of bias especially among surgical studies. The results showed comparable RTPrate between surgical and rehabilitative interventions within the three diagnostic groups. Rehabilitation had significantly quicker RTPtime for pubic related groin pain compared to surgery (10.5 weeks and 23.1 weeks respectively). The abdominal group had the fastest return of the three groups for the rehabilitation and surgery.
  
  
  CONCLUSIONS
  The review suggested better outcomes with rehabilitation for pubic-related groin pain with no difference between the adductor and abdominal groups. The review highlighted the poor quality and risk of bias in the literature making accurate comparison difficult.
authors.affiliation: Department of Sports Medicine, Sports Surgery Clinic, Dublin, Ireland Department of Life Sciences, Roehampton University, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: King
authors.affiliation: Department of Sports Medicine, Sports Surgery Clinic, Dublin, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Ward
authors.affiliation: School of Mathematical Sciences and Insight Research Centre, University College Dublin, Dublin, Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Small
authors.affiliation: Department of Sports Medicine, Sports Surgery Clinic, Dublin, Ireland Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia Department of Medicine, University College Cork, Ireland Irish Rugby Football Union, Dublin, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: Falvey
authors.affiliation: Department of Sports Medicine, Sports Surgery Clinic, Dublin, Ireland Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Franklyn-Miller
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000534:rehabilitation / Q000601:surgery*; D001265:Athletic Injuries / Q000175:diagnosis / Q000534:rehabilitation / Q000601:surgery*; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D006119:Groin; D006801:Humans; D026741:Physical Therapy Modalities; D000068958:Return to Sport / Q000502:physiology; D013177:Sports / Q000502:physiology*
keywords: Exercise rehabilitation; Groin; Lower limb surgery; Physiotherapy