Acute Adductor Muscle Injury: A Systematic Review on Diagnostic Imaging, Treatment, and Prevention

Abstract

Background: Controversies remain regarding the diagnosis, imaging, and treatment of acute adductor injuries in athletes. Purpose: To investigate the diagnostic imaging, treatment, and prevention of acute adductor injuries based on the most recent and relevant scientific evidence. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed and Web of Science databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify articles studying acute adductor injury in athletes. Inclusion criteria were original publication on acute adductor injury in amateur or professional athletes, level 1 to 4 evidence, mean patient age >15 years, and results presented as return-to-sport, pain, or functional outcomes. Quality assessment was performed with the CONSORT (Consolidated Standards of Reporting Trials) statement or the methodological index for non-randomized studies criteria. Articles were grouped as imaging, treatment, prevention focused, or mixed. Results: A total of 30 studies published between 2001 and 2021 were selected, involving 594 male patients with a mean age 26.2 years (range, 16-68 years). The most frequent sports were soccer (62%), basketball (14%), futsal (6%), American football (3%), and ice hockey and handball (2%). Risk factors for acute adductor injury were previous acute groin injury, adductor weakness compared with the uninjured side, any injury in the previous season, and reduced rotational hip range of motion. The frequency of complete adductor muscle tears on magnetic resonance imaging was 21% to 25%. For complete adductor tears, the average time to return to play was 8.9 weeks in patients treated nonoperatively and 14.2 weeks for patients treated surgically. Greater stump retraction was observed in individuals treated surgically. Partial acute adductor tears were treated nonoperatively with physical therapy in all studies in the present systematic review. The average time to return to play was 1 to 6.9 weeks depending on the injury grade. The efficacy of adductor strengthening on preventing acute adductor tears has controversial results in the literature. Conclusion: Athletes with partial adductor injuries returned to play 1 to 7 weeks after injury with physical therapy treatment. Nonoperative or surgical treatment is an acceptable option for complete adductor longus tendon tear.

Isolated adductor longus avulsion in a young semi‐professional football player: Imaging contribution and therapeutic considerations

“…Second, we considered that the conservative treatment usually provides early RTP at the same pre-injury level with no additional risk of recurrence. Comparative studies have shown that athletes undergoing a conservative approach experience a faster recovery compared to those undergoing surgical re-attachment (3-12 vs. 10-16 weeks), 8,12,15 although the surgical group was composed of patients with more severe injuries. However, in our case, the player resumed sport activity after 16 weeks (a longer time compared to other cases where conservative strategies were used), as we waited that all RTP criteria were fully satisfied (subjective and objective measures).…”

“…5,7 Adductor injuries are usually observed at the proximal musculotendinous junction, but tendinous ruptures at the origin on the pubic bone, known as avulsions, are uncommon. 8 These injuries can occur in isolation or with associated lesions of the pyramidal and/or pectineus muscles or anterior pubic ligament, forming the so-called pyramidalisanterior pubic ligament-AL complex (PLAC). 9 In football (also called soccer in the United States), these lesions are commonly observed (about 23% of the muscle injuries) in middleaged athletes (22-30 years old) who engage in activities that require strenuous and vigorous movements, particularly in a position of wide hip adduction with extension and internal rotation (kicking, shooting, sprinting, and change of direction).…”

“…Adductor injuries are usually observed at the proximal musculo‐tendinous junction, but tendinous ruptures at the origin on the pubic bone, known as avulsions, are uncommon 8 . These injuries can occur in isolation or with associated lesions of the pyramidal and/or pectineus muscles or anterior pubic ligament, forming the so‐called pyramidalis‐anterior pubic ligament‐AL complex (PLAC) 9 …”

Surgical Reattachment of Rare Proximal Adductor Avulsion Injury in a Female Athlete

“…We corroborate existing literature demonstrating that surgical reattachment for proximal adductor avulsion injuries leads to restoration of preinjury levels of function. n Alex Chang, BS 1 Mark Zoland, MD 1 Srino Bharam, MD, MBA 1 1 Lenox Hill Hospital, New York, New York Email address for S. Bharam: srino.bharam@gmail.com…”

“…Athletic groin injuries are commonly encountered in sports that involve abrupt changes in speed and direction 1-3 . Proximal adductor avulsion injuries are a relatively uncommon and severe subset of groin injury that occurs when the adductor longus muscle tendon completely separates from its origin at the pubis.…”