Characteristics of acute groin injuries in the adductor muscles: A detailed MRI study in athletes

Abstract

Acute adductor injuries account for the majority of acute groin injuries; however, little is known about specific injury characteristics, which could be important for the understanding of etiology and management of these injuries. The study aim was to describe acute adductor injuries in athletes using magnetic resonance imaging (MRI). Male athletes with acute groin pain and an MRI confirmed acute adductor muscle injury were prospectively included. MRI was performed within 7 days of injury using a standardized protocol and a reliable assessment approach. 156 athletes presented with acute groin pain of which 71 athletes were included, median age 27 years (range 18-37). There were 46 isolated muscle injuries and 25 athletes with multiple adductor injuries. In total, 111 acute adductor muscle injuries were recorded; 62 adductor longus, 18 adductor brevis, 17 pectineus, 9 obturator externus, 4 gracilis, and 1 adductor magnus injury. Adductor longus injuries occurred at three main injury locations; proximal insertion (26%), intramuscular musculo-tendinous junction (MTJ) of the proximal tendon (26%) and the MTJ of the distal tendon (37%). Intramuscular tendon injury was seen in one case. At the proximal insertion, 12 of 16 injuries were complete avulsions. This study shows that acute adductor injuries generally occur in isolation from other muscle groups. Adductor longus is the most frequently injured muscle in isolation and in combination with other adductor muscle injuries. Three characteristic adductor longus injury locations were observed on MRI, with avulsion injuries accounting for three-quarters of injuries at the proximal insertion, and intramuscular tendon injury was uncommon.

Diagnosis of acute groin injuries in athletes

“…Adductor injuries were most common (≈66% injuries), followed by hip flexor injuries (≈33%) 1 4 5. Adductor longus is the most frequently injured muscle, and has three characteristic injury locations: proximal insertion, musculotendinous junction (MTJ) of the proximal tendon and MTJ of distal tendon 4. Proximal rectus femoris injuries often included injury to the tendon itself, predominantly the indirect tendon 5.…”

Mechanisms of acute adductor longus injuries in male football players: a systematic visual video analysis

“…In football, most acute adductor injuries are reported to occur during kicking or changing direction 5. One study attempted to analyse groin injuries in football using video footage, but none of the seven groin injuries reported could be identified on video 7.…”

Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management

“…Acute strains often occur at the musculotendinous junction, specifically of the adductor longus, rectus femoris, and iliopsoas muscles. 87,88 Acute adductor longus and rectus femoris injuries may also involve tendinous rupture/ avulsion, primarily at the proximal insertions (FIGURE 2). 87,88 In contrast to strains, groin overuse injuries more often involve bone and tendons and their insertions, and rarely involve the rectus femoris.…”

“…87,88 Acute adductor longus and rectus femoris injuries may also involve tendinous rupture/ avulsion, primarily at the proximal insertions (FIGURE 2). 87,88 In contrast to strains, groin overuse injuries more often involve bone and tendons and their insertions, and rarely involve the rectus femoris. 34 Acute adductor muscle injuries usually occur during kicking and change of direction.…”

“…Imaging may be considered to determine the initial severity of acute adductor muscle strains. Avulsion injuries account for a high proportion of injuries at the proximal adductor longus insertion, 87 and these injuries generally have a longer rehabilitation time than lower-grade injuries. 79,107 Therefore, if an avulsion is suspected, ultrasonography or MRI can be used for confirmation.…”