title: Athletic groin pain: a systematic review of surgical diagnoses, investigations and treatment.
abstract: BACKGROUND
  Athletic groin pain requiring surgery remains a diagnostic and therapeutic challenge. This systematic review aims to identify the most common causes of groin pain in athletes requiring surgery. Additionally, it aims to further characterise their susceptible athlete profiles, common physical examination and imaging techniques, and surgical procedures performed. This will enable the orthopaedic sports medicine clinician/surgeon to best treat these patients.
  
  
  METHODS
  The electronic databases MEDLINE, PubMed and EMBASE were searched from database inception to 13 August 2014 for studies in the English language that addressed athletic groin pain necessitating surgery. The search was updated on 4 August 2015 to find any articles published after the original search. The studies were systematically screened and data were abstracted in duplicate, with descriptive data presented.
  
  
  RESULTS
  A total of 73 articles were included within our study, with data from 4655 patients abstracted. Overall, intra-articular and extra-articular causes of groin pain in athletes requiring surgery were equal. The top five causes for pain were: femoroacetabular impingement (FAI) (32%), athletic pubalgia (24%), adductor-related pathology (12%), inguinal pathology (10%) and labral pathology (5%), with 35% of this labral pathology specifically attributed to FAI.
  
  
  CONCLUSIONS
  Given the complex anatomy, equal intra-articular and extra-articular contribution, and potential for overlap of clinical entities causing groin pain leading to surgery in athletes, further studies are required to ascertain the finer details regarding specific exam manoeuvres, imaging views and surgical outcomes to best treat this patient population.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada.
authors.forename: Darren
authors.initials: D
authors.lastname: de Sa
authors.affiliation: Sports Orthopaedic Research Center-Copenhagen, Arthroscopic Centre Amager, Copenhagen University Hospital, Amager-Hvidovre, Denmark Sports Groin Pain Center, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Per
authors.initials: P
authors.lastname: Hölmich
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Phillips
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Heaven
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Simunovic
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Philippon
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada.
authors.forename: Olufemi R
authors.initials: OR
authors.lastname: Ayeni
mesh_terms: D056352:Athletes; D001265:Athletic Injuries / Q000175:diagnosis* / Q000601:surgery*; D006119:Groin / Q000293:injuries / Q000473:pathology*; D006801:Humans; D059352:Musculoskeletal Pain / Q000175:diagnosis; D017699:Pelvic Pain / Q000175:diagnosis* / Q000601:surgery*; D010808:Physical Examination
keywords: Groin; Hip; Review; Surgery