TablE 3.
The characteristics of the considered studies.
| Reference | Study design and level of evidence | Participants and study setting | Diagnosis | Type of rehabilitation | Follow-up | Time loss injury | Outcome | Complications | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dallaudière et al., 201448 |
Case series (level of evidence IV) | 41 subjects. Age: 44.4 ± 12.4 years, sex and sport activity were not specified | Longstanding adductor-related GPS | PRPt. single intratendinous US-guided PRP injection X3 with no adjuvant | 6 weeks and 32 months | Not specified | At 6 weeks follow-up the US residual tendinopatyhy signs was lower than the baseline signs observed before the PRPt. At 32 monts follow-up QuickDASH score and WOMAC was significantly improved | None | ||||||||||
| Holmich, 199922 | RCT (level of evidence II) | 68 athletes. 34 subjects in AT group (age 30 years, range 20–50 years) of which 26 (76%) performed soccer and 8 (24%) other sports. 34 subjects in PT group (age 30 years, range 21–50 years) of which 28 (82%) performed soccer and 6 (18%) performed other sports activity. | Longstanding adductor-related GPS | AT group: active training and physiotherapy (laser, friction massage, stretching of adductor and transcutaneous electrical nerve stimulation). PT group: physiotherapy only. Or both groups the treatment period was compromised between 8 and 12 weeks |
4 weeks and 4 months | AT group 18.5 weeks. PT group not specified | In the AT group, 23 (67.6%) subjects return to sport activity at the previous level after in average 18.5 weeks. In PT group, 5 subjects (14.7%) of athletes return to previous sport level without pain (time loss injury was not specified |
None | ||||||||||
| Holt et al., 199545 | Case series (level of evidence IV) | 12 athletes (10 males and 2 females, age range 20–35 years). Sport activity was not specified. | Longstanding adductor-related GPS | Corticosteroid injection (1 ml 1% lidocaine, 1 ml 0.25% bupivacaine, and 4 mg dexamethasone) at pubic symphysis level | 12 months (range 6–24 months) | 10.9 ± 8.3 weeks range 3–24 weeks) | 3 athletes (27.2%) pain free after 1 injection, 3 (27.2%) pain free after 2 injections and needed between 11 and 16 weeks for the full recovery, 1 (9%) underwent 3 injections and became pain free after 24 weeks, and 1 (9%) received 3 injections and became symptom free after 24 weeks. 1 subject (9%) had no improvement | None | ||||||||||
| Masala et al 201735 | Case series (level of evidence IV) | 32 subjects: 9 (28.1%) soccer players, 7 (21.9%) long-distance runners, 6 (18.7%) high jumpers, 4 (12.5%) swimmers, 2 (6.2%) hockey athletes and 4 (12.5%) other sport activities. Age 26 ± 7.7 years (18.3–33.7), 13 males and 19 females | Longstanding adductor-related GPS | PDRt on the genital branches of obturator nerve, genito-femoral nerve, ilio-inguinal and ilio-hypogastric nerves. | 1, 3, 6 and 9 months | Not specified | Follow-up at 9 months showed a decrease (at least 50%) in pain value (VAS scale) in 31 patient over 32 (96.9%). | None | ||||||||||
| McKim and Taunton 200129 |
Case series (level of evidence IV) | 10 subjects (8 males and 2 female age and sport activity not specified) | Longstanding adductor-related GPS | Effectiveness of a compression short during sport activity. | Not specified | Not specified | Compression shorts significantly reduce groin and pelvic pain during exercises. A quicker return to sport activity may be possible while wearing the compression shorts. | A slight decrement in performance may ensue. | ||||||||||
| Mens et al. 200631 | Cross sectional study | G1 composed by 44 athletes (32 men and 12 women; age: 31.3 years, range: 28.1–34.6) affected by longstanding adductor-related GPS. G2 composed by 44 healthy sports subjects (32 men and 12 women; age: 32.2 years, range:30.0–35.4) | Adductor-related GPS with a duration of at least 1 month with positive squeeze test | Pelvic belt of non-elastic material | Not reported | G1 showed improvement in force value and decreasing in pain value during squeeze test performed with pelvic belt. | None | |||||||||||
| Moreno et al. 201734 | RCT (level of evidence II) | SG 10 non-professional players and 12 non-professional football players. CG 12 non-professional (age 26.0 ± 4.7 year; height 178.7 ± 8.0 cm; body mass 73.9 ± 6.9 kg) | Longstanding adductor-related GPS | SG: intratissue percutaneous electrolysis 2 times a week and physiotherapeutic exercise. CG : physiotherapeutic exercise. | 6 months after the end of treatment | Non specified) | SG and CG showed a significant improvement in NRS, NRScontr and PSFS. SG a greater and faster reduction of pain in NRS and NRScontr in comparison to CG | None | ||||||||||
| O’Connell et al., 200246 | Case series (level of evidence IV) | 16 athletes (14 men and 2 women average age equal to 28.4 years range 20–41 years). Sport activity was not specified. | Longstanding adductor-related GPS | Single corticosteroid injection (20 mg of methyprednisolone acetate and 1 ml of 0.5% bupivacaine hydrochloride | 2 weeks, 3 months and 6 months after injection | Not specified | At 6 months follow up symptoms persisted in 31.25% (5 patients), and 12.5% (2 patients) at symptoms of provocation test. | None | ||||||||||
| Otten et al. 201933 | Double blinded RCT | 34 males amateur football players (age 25 ± 5 years, range: 18–37) | Adductor-related GPS from > 4 weeks | High compression shorts (ZHCshorts), non-zoned low compression shorts (NZLC-shorts) | 2 weeks | Not reported | Pain reduction measured with Numeric Pain Rating Scale and HAGOS questionnaire with the use of ZHCshorts | None | ||||||||||
| Sawle et al 201932 | Pilot blinded RCT | 16 athletes (13 men and 3 women, 8 recreationals and 8 professionals). Study group (SG): 9 subjects, age :26 +/- 5.3 years (range:23–36). Control group (CG), 8 subjects, age: 30.7 +/- 9.3 years (range. 22–48). | Sub-acute (1–3 months duration) and chronic (> 3 months) adductor-related GPS clinically assessed. | Customized compression shorts delivering targeted compression to the pelvic girdle | 1-2-4-6-weeks | Not reported | The SG subjects showed moderate to large estimated effect sizes (d = 0.6–1.1) on clinical test while wearing customized compression shorts. On the contrary, they showed a small effect sizes (d = 0.2) on performance tests | None | ||||||||||
| Schilders et al., 200747 | Case series (level of evidence IV) | 24 competitive male athletes: 18 (75%) professional soccer players, 2 (8.3%) professional rugby players, 2 (8.3%) Olympic track and field athletes, 1(4.2%) semi-professional soccer player and 1 (4.2%) squash player, whose mean age was 27.7 years, range 19–41 years). G1: 7 subjects without MRI signs for adductor longus tendinopathy and /or enthesopathy. G2:17 subjects with MRI signs for adductor longus tendinopathy and /or enthesopathy | Longstandingadductor-related GPS | Triamcinolone acetonide -80 mg in 2 ml mixed with marcaine-bupivacaine -3 ml of 0.5% solution | 1 year | Not reported | Performed by questionnaire. None of the G1 subjects had recurrence. 16 (94.1%) of the G2 subjects had recurrence of the symptoms (p < 0.001) at a mean of 5 weeks (range, 1–16 weeks) after the injection |
None | ||||||||||
| Schilders et al., 200926 | Case series (level of evidence IV) | G1 composed by 15 patients (22 years, range 18–40) not showing MRI signs of adductor longus tendinophaty. G2 composed by 13 patients showing MRI signs of adductor longus tendinophaty. Sport activity not specified.. | Longstanding adductor-related GPS | Triamcinolone acetonide -80 mg in 2 ml mixed with marcaine-bupivacaine -3 ml of 0.5% solution | 6 weeks and 1 year | Not reported | At 1 year follow up, 33.3% (5 subjects) belonging to G1 had recurrence of the symptoms, and 30.7% (4 subjects) of G2 showed a symptoms recurrence. | None | ||||||||||
| Topol et al., 200528 | Case series (level of evidence IV) | 24 athletes (22 rugby and 2 male soccer players, average age equal to 25 years) | Longstanding adductor-related GPS | Prolotherapy based on a monthly injection of 12.5% dextrose and 0.5% lidocaine into the adductor longus origins (mean 2.8 treatments) | 6 and 32 months after therapy | Between 6 weeks and 3 months | The VAS score improved 6.3+/-1.4 to 1.0+/-2.4 (p < .001). NPPS score improved from 5.3+/-0.7 to 0.8+/-1.9 (p < .001). Twenty-two (91.6%) subjects returned to play with any restrictions. | None | ||||||||||
| Topol and Reeves, 200827 | Case series (level of evidence IV) | 72 athletes 39 subject (54.1%) were rugby players, 29 (40.3%) football players, and 4 (5.5%) practiced other sports. Age and sex not specified | Longstanding adductor-related GPS | Prolotherapy based on a monthly injection of 12.5% dextrose and 0.5% lidocaine into the adductor longus origins (mean 2.8 treatments) | 26 months (range 6–73) | 3 months (1–5 months) | VAS improvement was 82% (p < 0.001) and Nirschl Pain Phase Scale improvement was 78% (p < 0.001). Sixty-six (91.7%) subjects returned to play with any restrictions. | None | ||||||||||
| Weir et al., 200949 | Retrospective case series (level of evidence IV) | 30 athletes (27 mean and 3 woman) athletes average age 20.5 years) 23 (77%) soccer players, 4 (30%) tennis players, 2 (7%) speed skaters, 1 (3%) distance runner | Longstanding adductor-related groin pain | Manual therapy | 6–12 months after treatment | Not specified | The level of satisfaction: 4 athletes (47%) excellent, for 11 (37%) good, for 3 (10%) fair, and for 2 (6%) poor. 15 athletes (50%) returned at sport activity at pre injury level, 12 (40%) returned under preinjury level specified) and 3 (10%) did not return to sport | None | ||||||||||
| Weir et al., 201050 | Retrospective case series (level of evidence IV) | 44 subjects. men 37, women 7 Age 27 (+/-10.8) Soccer 31 (70.4%), running 3 (6.8%), Field hockey 3 (6.8%), tennis 2 (4.5%), other sports 5 (11.3%) |
Longstanding adductor-related GPS | Mobilization, core exercises, general whole body stabilizing exercises, agility drills and sport specific exercises. | 6.5–51 months | Not specified | At the end of the treatments 38 athletes (86%) returned to the same level of sport, and 34 athletes (77%) were asymptomatic. At 6.5–51 months follow up 10 over the previous mentioned 38 athletes (26%), and 22 athletes (50%) were able to participate in their sport activity in the same level without any restriction |
The risk for recurrence was high. | ||||||||||
| Weir et al., 201123 | Single blinded, RCT (level of evidence II) | 54 subjects. G1 group 25 subjects (age 27.4 +7.3 years). G2 group: 29 subjects (age 28.7+8.2 years). Sport activity not specified. | Longstanding adductor-related GPS. | Exercise therapy (G1) versus multi modal treatment (G2) | 0, 6, 16, and 24 weeks | G1: 17.3 ± 4.4 weeks. G2: 12.8 ± 6.0 weeks. |
In G1 50% (13/26) returned to full sport participation versus 55% (12/22) in G2. The difference was not significant. G2 subjects returned to sports quicker than G1 subjects (12.8 ± 6.0 versus 17.3 ± 4.4 weeks, p < 0.05). | None | ||||||||||
| Yousefzadeh et al. 2018°24 | Case series (level of evidence IV) | 15 men athletes (mean age 26.13 ± 4.48 years, range 18–35 years). Sport activity non specified. | Longstanding adductor-related GPS | 10-weeks modified Hölmich therapeutic exercise protocol | 10 weeks | 10.9 ± 8.3 weeks range 3–24 weeks) | Significantl improvement in comparison to the baseline of IHAB, EHAB, EHAD and EHAD/EHAB ratio. Significant improvement in VAS scores. T-test, THT and ESST. The ROM increased significantly. 13 athletes (86.6%) returned to full sports activity in 12.06 ± 3.41 weeks |
None | ||||||||||
| Yousefzadeh et al. 2018b25 | Case series (level of evidence IV) | 17 male athletes (mean age 25.07 ± 4.96 years). Sport activity non specified. | Longstanding adductor-related GPS | 10-weeks Hölmich therapeutic exercise protocol | 12.06 ± 3.41 weeks | 10.9 ± 8.3 weeks range 3–24 weeks) | Statistical improvement in comparison to the baseline data of IHAB, EHAB, EHAD and EHAD/EHAB ratio. A significant improvement in VAS pain scores. T-test, THT and ESST. The ROM increased significantly. 11 athletes (78.57%) returned to their sports activities in 14.2 weeks (range, 10–20 weeks |
None | ||||||||||