BackgroundHeterogeneous taxonomy of groin injuries in athletes adds confusion to this complicated area.AimThe ‘Doha agreement meeting on terminology and definitions in groin pain in athletes’ was convened to attempt to resolve this problem. Our aim was to agree on a standard terminology, along with accompanying definitions.MethodsA one-day agreement meeting was held on 4 November 2014. Twenty-four international experts from 14 different countries participated. Systematic reviews were performed to give an up-to-date synthesis of the current evidence on major topics concerning groin pain in athletes. All members participated in a Delphi questionnaire prior to the meeting.ResultsUnanimous agreement was reached on the following terminology. The classification system has three major subheadings of groin pain in athletes:1. Defined clinical entities for groin pain: Adductor-related, iliopsoas-related, inguinal-related and pubic-related groin pain.2. Hip-related groin pain.3. Other causes of groin pain in athletes.The definitions are included in this paper.ConclusionsThe Doha agreement meeting on terminology and definitions in groin pain in athletes reached a consensus on a clinically based taxonomy using three major categories. These definitions and terminology are based on history and physical examination to categorise athletes, making it simple and suitable for both clinical practice and research.

Rehabilitation time was related to MR measurements such as the percentage of abnormal muscle area and approximate volume of muscle injury. Hamstring injury most frequently involved the long head of the biceps femoris muscle, and involvement of the intramuscular tendon was common.

Objective-To prospectively establish risk factors for hamstring muscle strain injury using magnetic resonance imaging (MRI) to define the diagnosis of posterior thigh injury. Method-In a prospective cohort study using two elite Australian Rules football clubs, the anthropometric characteristics and past clinical history of 114 athletes were recorded. Players were followed throughout the subsequent season, with posterior thigh injuries being documented. Hamstring intramuscular hyperintensity on T2 weighted MRI was required to meet our criteria for a definite hamstring injury. Statistical associations were sought between anthropometric and previous clinical characteristics and hamstring muscle injury. Results-MRI in 32 players showed either hamstring injury (n = 26) or normal scans (n = 6). An association existed between a hamstring injury and each of the following: increasing age, being aboriginal, past history of an injury to the posterior thigh or knee or osteitis pubis (all p<0.05). These factors were still significant when players with a past history of posterior thigh injury (n = 26) were excluded. Previous back injury was associated with a posterior thigh injury that looked normal on MRI scan, but not with an MRI detected hamstring injury. Conclusions-Hamstring injuries are common in Australian football, and previous posterior thigh injury is a significant risk factor. Other factors, such as increasing age, being of aboriginal descent, or having a past history of knee injury or osteitis pubis, increase the risk of hamstring strain independently of previous posterior thigh injury. However, as the numbers in this study are small, further research is needed before definitive statements can be made. (Br J Sports Med 2001;35:435-440)

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Objectives-To examine the relation between the clinical features of groin pain and groin magnetic resonance imaging (MRI) appearances in a group largely comprising elite Australian Rules football players. The incidence of bone marrow oedema and other MRI findings in the pubic symphysis region was noted. The relation between a past history of groin pain and these other MRI findings was also examined. Method-In a prospective study, 116 male subjects (89 footballers, 17 umpires, 10 sedentary men) were examined before history taking and groin MRI. The clinical history was not known to the examiner (GMV) and radiologists (JPS, GTF). Clinical evidence of groin pain and examination findings were correlated with the presence of increased signal intensity within the pubic bone marrow. A past history of groin pain was correlated with the presence of other MRI findings such as cyst formation, fluid signal within the pubic symphysis disc, and irregularity of the pubic symphysis. Results-Fifty two athletes (47 footballers, five umpires) had clinical features of groin pain with pubic symphysis and/or superior pubic ramus tenderness. A high incidence of increased signal intensity (77%) within the pubic bone marrow was identified in this group. There was an association between this group of athletes and the MRI finding of increased signal intensity (p<0.01). There was also an association between a past history of groin pain and the presence of other MRI findings (p<0.01). Conclusions-Athletes with groin pain and tenderness of the pubic symphysis and/or superior pubic ramus have clinical features consistent with the diagnosis of osteitis pubis. The increased signal intensity seen on MRI is due to pubic bone marrow oedema. An association exists between the clinical features of osteitis pubis and the MRI finding of pubic bone marrow oedema. A high incidence of pubic bone marrow oedema was also noted. Degenerative features visualised by MRI, such as subchondral cyst formation, were associated with a past history of groin pain. A stress injury to the pubic bone is the most likely explanation for these MRI findings and may be the cause of the clinical entity osteitis pubis. (Br J Sports Med 2001;35:28-33)