Do we need another randomised controlled trial for sportsman's groin?

backgroundSportsman’s groin, more accurately termed inguinal disruption or inguinal-related groin pain, represents a complex and heterogeneous clinical entity. Despite growing consensus on terminology and advances in imaging modalities and rehabilitation strategies, significant uncertainty remains regarding optimal management, particularly in relation to surgical intervention.

methodsThis narrative review evaluates the current literature on the diagnosis, nomenclature, and surgical management of sportsman’s groin. Emphasis is placed on the quality of available evidence, including the predominance of retrospective series and technique-specific reports, as well as the limited number of randomised controlled trials.

resultsSurgical treatment is recognised as an appropriate option in selected patients who fail conservative management. However, the evidence base is limited, with only one randomised controlled trial reported to date. Diagnostic challenges persist, particularly in relation to clinical heterogeneity and the limitations of imaging in accurately identifying the underlying pathology. Current studies largely focus on comparisons between open and laparoscopic techniques, with insufficient attention given to the fundamental distinction between mesh-based and suture-based repairs.

conclusionSportsman’s groin remains a poorly defined and variably managed condition. There is a clear need for improved diagnostic stratification to guide treatment selection. Future research should prioritise high-quality randomised controlled trials, with particular focus on the comparative effectiveness of mesh versus suture repair, rather than solely on surgical approach.