Athletes With Adductor-Related Groin Pain: A Narrative Review

Adductor-related groin pain is extremely common among athletes, and despite its high prevalence and impact, there is no consensus regarding taxonomy, anatomy, physiopathology, or treatment. We performed a comprehensive literature review and tried to demystify this pathology and its treatment. The Doha agreement classification and its impact are scrutinized as well as the complexity of the proximal adductor longus (AL) insertion and its relationship with the pyramidalis-anterior pubic ligament-AL complex. The stress-shielding and compression theories for the origin of AL tendon pathology are exploited along with how this knowledge translates into injury prevention protocols and surgical techniques. The importance of active rehabilitation protocols and intersegmental control-focused programs is highlighted. The role of an enthesis injection in the treatment algorithm is discussed along with when to perform a tenotomy. The differences between selective and complete tenotomy are highlighted.