Characteristics of acute groin injuries in the hip flexor muscles — a detailed MRI study in athletes

Abstract

Hip flexor injuries account for one-third of acute groin injuries; however, little is known about specific injury characteristics. The aims of this study were to describe acute hip flexor injuries using magnetic resonance imaging (MRI) in athletes with acute groin pain and to compare specific muscle injuries with reported injury situations. Male athletes with acute groin pain were prospectively and consecutively included during three sports seasons. MRI was performed within 7 days of injury using a standardized protocol and a reliable assessment approach. All athletes with an MRI confirmed acute hip flexor muscle injury were included. A total of 156 athletes presented with acute groin pain of which 33 athletes were included, median age 26 years (range 18-35). There were 16 rectus femoris, 12 iliacus, 7 psoas major, 4 sartorius, and 1 tensor fascia latae injury. Rectus femoris injuries primarily occurred during kicking (10) and sprinting (4), whereas iliacus injuries most frequently occurred during change of direction (5). In 10 (63%) rectus femoris injuries, tendinous injury was observed. The iliacus and psoas major injuries were mainly observed at the musculotendinous junction (MTJ), and two included tendinous injury. We have illustrated specific injury locations within these muscles, which may be relevant for the clinical diagnosis and prognosis of these injuries. Most proximal rectus femoris injuries included tendinous injury. In contrast, distinct acute iliacus and psoas injuries predominantly occurred at the MTJ. Only the iliacus or psoas major were injured during change of direction, whereas rectus femoris injuries occurred primarily during kicking and sprinting.

Diagnosis of acute groin injuries in athletes

“…Adductor longus is the most frequently injured muscle, and has three characteristic injury locations: proximal insertion, musculotendinous junction (MTJ) of the proximal tendon and MTJ of distal tendon 4. Proximal rectus femoris injuries often included injury to the tendon itself, predominantly the indirect tendon 5. Iliopsoas injuries can be divided into distinct iliacus and psoas injuries, with iliacus injuries being most frequent (92%), and predominantly occurred at the MTJ 5…”

Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management

“…Acute strains often occur at the musculotendinous junction, specifically of the adductor longus, rectus femoris, and iliopsoas muscles. 87,88 Acute adductor longus and rectus femoris injuries may also involve tendinous rupture/ avulsion, primarily at the proximal insertions (FIGURE 2). 87,88 In contrast to strains, groin overuse injuries more often involve bone and tendons and their insertions, and rarely involve the rectus femoris.…”

“…87,88 Acute adductor longus and rectus femoris injuries may also involve tendinous rupture/ avulsion, primarily at the proximal insertions (FIGURE 2). 87,88 In contrast to strains, groin overuse injuries more often involve bone and tendons and their insertions, and rarely involve the rectus femoris. 34 Acute adductor muscle injuries usually occur during kicking and change of direction.…”

“…84 In comparison, acute rectus femoris injuries primarily occur during kicking and sprinting, whereas acute iliacus and psoas major injuries mainly occur with movement requiring change of direction. 88 Runners and dancers can also present with groin pain, often due to overuse. Hip flexor injuries, hip joint pain, and stress fractures are the most common injuries seen in these individuals, 8,43,47,66 and, like most other overuse injuries, these are more often related to repetitive and accumulated overload.…”

Short‐term Effect of Ultrasound‐Guided Iliopsoas Peritendinous Corticosteroid Injection

“…The iliopsoas has been recently implicated in 25% of acute groin injuries . Other studies similarly indicated that iliopsoas disorders were found in 25% to 30% of athletes with acute groin injury and 12% to 36% of athletes with chronic groin pain . Common injury mechanisms involve kicking, sprinting, and changes of direction in sports such as soccer, basketball, and handball .…”