Adductor tenotomy: its role in the management of sports-related chronic groin pain

Atkinson, Henry Dushan; Johal, Parminder; Falworth, Mark; Ranawat, Vijai; Dala-Ali, Benan; Martin, David K.

doi:10.1007/s00402-009-1032-4

Cited by 99 publications

(95 citation statements)

References 12 publications

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“…Functionally, an intramuscular tendon may provide extra strength and stability during muscle contraction and could be especially important in muscles such as AL whereby the MTJ is subjected to large mechanical stresses 31 32. From a clinical perspective, adductor injury can occur at the proximal tendon or MTJ,11 12 15 16; awareness of the existence of an intramuscular tendon could therefore be important in diagnostic imaging. It is likely that previous reports of tendon and MTJ injuries affecting AL and AB have been limited to their surface tendons,15 16 27 and pathology affecting the intramuscular tendinous component may have been overlooked.…”

Section: Discussionmentioning

confidence: 99%

“…Acute rupture or avulsion of a proximal adductor tendon is rare 13 14. Chronic groin pain can result from conditions such as osteitis pubis, tendinopathy, enthesopathy, hip joint pathology and ‘sportsman’s hernia' 111215–20…”

Section: Introductionmentioning

confidence: 99%

“…Surprisingly, no study appears to have systematically investigated all these muscles in affected individuals. Similarly, little attention has been given to specifying the precise anatomical location of adductor-related groin pain: the proximal enthesis,15 18 20 25 proximal tendon,11 12 15 16 musculotendinous junction (MTJ)16 18 27 and muscle11 have each been identified as actual or potential sites of injury. However, with the exception of one study15 no data exist on the relative frequencies of injury at these various sites.…”

Section: Introductionmentioning

confidence: 99%

“…With regard to AB, it has been reported that only a small portion of its tendon is visible on the external surface of the muscle,30 which suggests the presence of an intramuscular tendon but this has yet to be confirmed. Since some cases of adductor-related groin pain may arise from an enthesopathy or tendinopathy,1115–171920 knowledge of enthesis composition and tendon vascularity also seem relevant. With the exception of a small case series indicating that the enthesis of AL is fibrocartilaginous,14 no other information is available on this subject.…”

Section: Introductionmentioning

confidence: 99%

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New insights into the proximal tendons of adductor longus, adductor brevis and gracilis

2011

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ObjectiveThe adductor muscles are implicated in the pathogenesis of groin strain, but the proximal morphology of this muscle group is poorly defi ned. The purpose of this study was to investigate the detailed anatomy of the entheses and proximal musculotendinous junctions (MTJs) of adductor longus (AL), adductor brevis (AB) and gracilis. Methods The adductors were dissected bilaterally in 10 embalmed cadavers (7 females, mean age at death 79 years (range 57-93 years)), focusing on the type of enthesis, and architecture of the proximal tendons and MTJs. Histology was used to determine if the entheses contained fi brocartilage and to semiquantitatively assess the vascularity of each proximal tendon. Results All entheses were fi brocartilaginous. The proximal tendons of AB and gracilis were fused, forming a common tendinous insertion in all specimens. AL and AB both contained extensive intramuscular tendons of variable length (AL 11.1 ± 1.5 cm; AB 5.4 ± 1.1 cm); this has not been recorded previously. The vascularity of AL and AB tendons decreased signifi cantly towards the enthesis (p < 0.05), and their entheses were significantly less vascular than that of gracilis (p < 0.05). Conclusions The proximal anatomy of AL, AB and gracilis is more complex than previously described. The arrangement and fusion of these muscles, their fi brocartilaginous entheses and differences in vascularity of their proximal tendons may be important anatomical considerations in the pathogenesis and pattern of adductorrelated groin pain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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New insights into the proximal tendons of adductor longus, adductor brevis and gracilis

2011

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“…The observed discharges from the Larra, Verdun, and Lamagistère gauging stations (see station locations in Figure 2c) were used for calibration. Sensitivity analysis and calibration were performed by SWAT-CUP with the SUFI-2 algorithm [38]. After sensitive parameters were identified, a 1500-run calibration was performed as recommended by Yang et al [37].…”

Section: Calibration and Evaluationmentioning

confidence: 99%

Using SWAT-LUD Model to Estimate the Influence of Water Exchange and Shallow Aquifer Denitrification on Water and Nitrate Flux

Sun

Bernard-Jannin

Grusson

et al. 2018

Water

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Numerous studies have pointed out the importance of groundwater and surface water interaction (SW-GW) in a river system. However; those functions have rarely been considered in large scale hydrological models. The SWAT-LUD model has been developed based on the Soil and Water Assessment Tool (SWAT) model; and it integrates a new type of subbasin; which is called subbasin-LU (SL); to represent the floodplain area. New modules representing SW-GW exchanges and shallow aquifer denitrification are developed in the SWAT-LUD model. In this study; the SWAT-LUD model was applied to the middle floodplain area of the Garonne catchment in France. The results showed that the SWAT-LUD model could represent the SW-GW exchange and shallow aquifer denitrification appropriately. An annual 44.1 × 10 7 m 3 of water flowed into the river from the study area; but the annual exchanged water volume was 6.4 × 10 7 m 3 ; which represented just 1% of the river discharge. A total of 384 tons of N-NO 3 − (0.023 t·ha −1 ) was consumed by denitrification in the floodplain shallow aquifer annually. The nitrate concentration (N-NO 3 − ) decrease in the channel was 0.12 mg·L −1 ; but in the shallow aquifer it reached 11.40 mg·L −1 ; 8.05 mg·L −1 ; and 5.41 mg·L −1 in LU1; LU2; and LU3; respectively. Our study reveals that; in the Garonne floodplain; denitrification plays a significant role in the attenuation of nitrate associated with groundwater; but the impacts of denitrification on nitrate associated with river water is much less significant.

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Groin Pain Syndrome Known as Sports Hernia

2020

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he incidence of groin pain among athletes is estimated to be from 2% to 20%; however, the incidence in the general population is unknown. Groin hernias and hip joint pathologic findings are common and often considered; once ruled out by physical examination with or without imaging, the differential diagnoses and workup of groin pain is confounding to many practitioners. This ambiguous nature of nonhernia, nonhip groin pain is understandable because routine physical examination often only reveals groin tenderness, and imaging may or may not have abnormalities. Most of the literature written about the subject are case series or opinions. Many of these case series only involve professional male athletes, and the reported end points are often: return to sport, time to return to sport, or level of sport. Thus, the level of evidence of the studies is low quality, and the findings may not be applicable to the general population. In the past 2 decades, treating practitioners have attempted to better classify and describe the common pattern of symptoms, examination and imaging findings, and noted anatomic abnormalities at the time of operative management. Common lexicon is necessary so that meaningful comparisons can be made. 1 The literature search for this narrative review is highlighted in the eFigure in the Supplement.Various nomenclature has been used for nonhernia, nonhip groin pain including athletic pubalgia, sports hernia, core muscle injury, Gilmore groin, sportsman groin, inguinal disruption, and several others. [2][3][4][5] Inclusion of the word hernia in the jargon is misrepresentative. We prefer the broad but descriptive term groin pain syndrome.

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Adductor tenotomy: its role in the management of sports-related chronic groin pain

Abstract: Adductor tenotomy provides good symptomatic and functional improvement in chronic adductor-related groin pain refractory to conservative treatment.

Cited by 99 publications

References 12 publications

New insights into the proximal tendons of adductor longus, adductor brevis and gracilis

New insights into the proximal tendons of adductor longus, adductor brevis and gracilis

Using SWAT-LUD Model to Estimate the Influence of Water Exchange and Shallow Aquifer Denitrification on Water and Nitrate Flux

Groin Pain Syndrome Known as Sports Hernia

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