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

ABSTRACT 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.