Long-Term Outcomes of Patients With Adductor-Related Groin Pain: Assessing the Clinical Relevance of Imaging-Only Hernias.

BACKGROUND: Groin pain is a common and diagnostically challenging presentation. Imaging often detects hernias that are not clinically evident ('imaging-only hernias') which can lead to unnecessary surgical intervention and under-diagnosis of musculoskeletal conditions like adductor-related groin pain (ARGP). This study evaluates long-term outcomes of patients diagnosed with ARGP in a variety of settings. METHODS: This was a retrospective study of patients diagnosed with ARGP (between January 2021 and June 2024) using the Groin-MAP. Patients were categorised into groups: (1) ARGP with imaging-only hernia, (2) ARGP with clinical inguinal hernia and (3) ARGP following inguinal hernia repair. Long-term patient-reported outcome measures were assessed. RESULTS: Follow-up was completed for 110 of 133 eligible patients at a median of 29 months (range 10-66). Group 1 (n = 47) reported 90% satisfaction after management of their adductor pain alone; only 1/47 had a hernia repair elsewhere. Group 2 (n = 29) reported 90% satisfaction with equivalent management of ARGP, but varied management for inguinal hernia. Up-front hernia repair was opted for by 14/29 and 15/29 opted for watchful waiting, of which 2 progressed to surgery. Group 3 (n = 34) had a higher symptom burden; yet 70% maintained mild or no activity limitation and 1/34 had revision hernia surgery. CONCLUSION: ARGP is under-recognised as a cause of groin pain in surgical practice, and is best diagnosed on physical examination. Patients with ARGP have good long-term outcomes without intervention for incidental imaging-only inguinal hernias. Those with clinical inguinal hernias might delay or avoid surgical repair by addressing concomitant ARGP.