Associations Between Initial Clinical Examination and Imaging Findings and Return-to-Sport in Male Athletes With Acute Adductor Injuries: A Prospective Cohort Study

Abstract

Background: Time to return-to-sport (RTS) after acute adductor injuries varies among athletes, yet we know little about which factors determine this variance. Purpose: To investigate the association between initial clinical and imaging examination findings and time to RTS in male athletes with acute adductor injuries. Study Design: Cohort study (Prognosis); Level of evidence, 2. Methods: Male adult athletes with an acute adductor injury were included within 7 days of injury. Standardized patient history and clinical and magnetic resonance imaging (MRI) examinations were conducted for all athletes. Athletes performed a supervised standardized criteria-based exercise treatment program. Three RTS milestones were defined: (1) clinically pain-free, (2) completed controlled sports training, and (3) first full team training. Univariate and multiple regression analyses were performed to determine the association between the specific candidate variables of the initial examinations and the RTS milestones. Results: We included 81 male adult athletes. The median duration for the 3 RTS milestones were 15 days (interquartile range, 12-28 days), 24 days (16-32 days), and 22 days (15-31 days), respectively. Clinical examination including patient history was able to explain 63%, 74%, and 68% of the variance in time to RTS. The strongest predictors for longer time to RTS were pain on palpation of the proximal adductor longus insertion or a palpable defect. The addition of MRI increased the explained variance with 7%, 0%, and 7%. The strongest MRI predictor was injury at the bone-tendon junction. Post hoc multiple regression analyses of players without the 2 most important clinical findings were able to explain 24% to 31% of the variance, with no added value of the MRI findings. Conclusion: The strongest predictors of a longer time to RTS after acute adductor injury were palpation pain at the proximal adductor longus insertion, a palpable defect, and/or an injury at the bone-tendon junction on MRI. For athletes without any of these findings, even extensive clinical and MRI examination does not assist considerably in providing a more precise estimate of time to RTS.

Return to Play in Long-Standing Adductor-Related Groin Pain: A Delphi Study Among Experts

“…Although imaging can be a valid diagnostic tool to support the clinical examination and identify red flags [ 41 ], to date no study supports its use in RTP decision. Therefore, our finding would seem in agreement with literature [ 42 , 43 ].…”

The Assessment, Management and Prevention of Calf Muscle Strain Injuries: A Qualitative Study of the Practices and Perspectives of 20 Expert Sports Clinicians

“…Investigations into muscle strains have focused on the predictive value of clinical and radiological factors on the time taken to RTP and recurrence, showing mixed evidence across the hamstrings [ 60 – 62 ], adductors [ 63 – 65 ] and calf [ 7 , 66 , 67 ]. Baseline clinical and radiological information may together help to estimate recovery after CMSI, whereas clinical factors best inform the risk of recurrence [ 7 , 8 , 31 ].…”

Adductor Muscle Injuries in UEFA Soccer Athletes: A Matched-Cohort Analysis of Injury Rate, Return to Play, and Player Performance From 2000 to 2015

“… 13 , 14 , 19 , 27 Nonetheless, the clinical outcomes after surgical intervention for adductor muscle injury have drastically improved in the past decade, as evident in the RTP rate of 54% in 2010 versus 93% in 2020 after tenotomy. 1 , 11 , 26 Personalized rehabilitation targeting at-risk functional movements may drive ongoing improvements in future rates of RTP.…”

“… 4 , 12 Time to RTP is a reasonable proxy variable, as it has been associated with adductor muscle injury grade. 24 – 26 Injuries were classified as minimal (0-3 day of absence), mild (4-7 days), moderate (8-28 days), and severe (>28 days). 12 …”