Nonoperative treatment and return to play after complete proximal adductor avulsion in high-performance athletes

Ueblacker, Peter; English, Bryan; Mueller-Wohlfahrt, Hans-Wilhelm

doi:10.1007/s00167-015-3669-6

Cited by 32 publications

(32 citation statements)

References 25 publications

(60 reference statements)

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“…The persistent aim of therapy remains to enhance muscle healing and to limit scar formation. Recently, several new injection methods were reported to shorten the recovery time after muscle strain injuries [4][5][6][7][8][9][10]. The injection of local anesthetics, Calf Blood Copmpound (CFC) and Homeo pathic Drug (Tr14), or platelet-rich plasma (PRP), was reported most frequently.…”

Section: Introductionmentioning

confidence: 99%

“…In vitro studies revealed that Tr14 inhibits the production of pro-inflammatory cytokines like TNF-α and IL-1β [18]. Although it was reported that athletes were successfully treated in practice [9,10], only limited scientific evidence can be found in the literature to support the general use of these agents in the treatment of muscle injuries. The exact mechanism of action of Calf Blood Copmpound (CFC) and Tr14 in the process of muscle healing is still not fully understood.…”

Section: Introductionmentioning

confidence: 99%

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Calf Blood Compound (CFC) and Homeopathic Drug Induce Differentiation of Primary Human Skeletal Muscle Cells

et al. 2019

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The use of injections to treat structural muscle injuries is controversially discussed. In our controlled in vitro study, we investigated the biological impact of Actovegin and Traumeel alone and in combination on primary human skeletal muscle cells. Cells were characterized by immunofluorescence staining for myogenic factor 5 (Myf5) and MyoD, and cultured with or without Actovegin and / or Traumeel. The effects of these agents were assayed by cell viability and gene expression of the specific markers MyoD, Myf5, neural adhesion molecule (NCAM), and CD31. Myotube formation was determined by myosin staining. Neither Actovegin nor Traumeel showed toxic effects or influenced cell viability significantly. High volumes of Actovegin down-regulated gene expression of NCAM after 3 days but had no effect on MyoD, Myf5, and CD31 gene expression. High volumes of Traumeel inhibited MyoD gene expression after 3 days, whereas after 7 days MyoD expression was significantly up-regulated. The combination of both agents did not significantly influence cell viability or gene expression. This is the first study demonstrating that Actovegin and Traumeel potentially modulate human skeletal muscle cells. The relevance of these in vitro findings has to be highlighted in further in vivo studies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Calf Blood Compound (CFC) and Homeopathic Drug Induce Differentiation of Primary Human Skeletal Muscle Cells

et al. 2019

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“…Whilst conservative management programmes have resulted in favourable outcomes, the scarcity of injury and variation in reported protocols precludes consensus on optimal rehabilitation. The criterion-based rehabilitation programme presented in this case followed the principles of progressive mechanical loading in tenopathology (Cook & Docking, 2015;Galloway, Lalley, & Shearn, 2013;Kjaer, 2014) and examples from other conservatively managed tendon avulsion cases in professional football (Fysentzou, 2016;Gamradt et al, 2009;Maciel et al, 2015;Ueblacker, English, & Mueller-Wohlfahrt, 2016). It is conceded that management principles utilised in this case derive heavily from published tendinopathy management approaches (Cook & Docking, 2015;Galloway, Lalley, & Shearn, 2013;Kjaer, 2014), which may not be fully appropriate in cases of tendon avulsion.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The potential for structural healing of the avulsed tendon is considered to exist with conservative management, as demonstrated in cases of lower limb tendon avulsion in professional football (Gamradt et al, 2009;Ueblacker et al, 2016). However, this was demonstrated at 12 weeks post-injury via MRI, but not at six weeks (Ueblacker et al, 2016). As such, it is considered unlikely that full structural healing occurred before return to play in this case, with transfer of the player to another club precluding repeat imaging to assess structural healing following extended rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

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2018

NZJP

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

Abate,

Sammarchi,

Calà

et al. 2023

J of Clinical Ultrasound

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Adductor longus injuries are usually observed at the proximal musculo‐tendinous junction, but isolated tendinous ruptures (i.e., avulsion) at the origin on the pubic bone are uncommon. In this article, we report a new case of isolated adductor longus avulsion that occurred in a young athlete and was treated with conservative therapy. An 18 years old semi‐professional football player, in the attempt to reach the ball with his right leg, reported acute pain and functional limitation in his left adductor area. Clinical examination showed tenderness on palpation associated with mild swelling. Manual strength testing of adductor muscles showed weakness and elicited moderate pain in the proximal groin region near the pubic bone. The diagnostic evaluations (ultrasound [3–14 MHz linear probe] and magnetic resonance imaging [1.5 Tesla magnetic field]), performed a few days after the event, showed a complete isolated avulsion of the proximal adductor longus tendon associated with a fluid collection, with a gap of about 9.5 mm from its insertion on the pubic bone. Degenerative alterations (sub‐chondral sclerosis, bone edema, erosions, cortical irregularities, calcifications) were found. These findings were crucial in the treatment choice because conservative management is suggested when the gap is below 1 cm and when no important displacement of proximal torn tendon's end at dynamic ultrasound is appreciated. A structured rehabilitation protocol was implemented, allowing the player to come back to his full athletic activity after 146 days. Return to play was allowed when several subjective and objective parameters were fully satisfied (full hip range of motion, pain‐free football‐specific activities, less than a 5%–10% difference in hip adduction strength between the injured and uninjured legs, advanced anatomical healing of the adductor longus tendon seen on diagnostic exams, and Hip And Groin Outcome Score [HAGOS] scores similar to baseline data). This case report emphasizes the importance of diagnostic imaging and clinical assessments in the management of an adductor longus avulsion with short retraction (about 1 cm). Both imaging techniques are non‐invasive and without risks, allow contra‐lateral examination and may guide in the treatment choice; moreover, they significantly influence the post‐care approach by enabling to fine‐tune a safe return to full athletic activity with minor re‐injury rate. While US can be used as primary imaging modality, MRI offers a higher level of accuracy.

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Nonoperative treatment and return to play after complete proximal adductor avulsion in high-performance athletes

Abstract: Case series, Level IV.

Cited by 32 publications

References 25 publications

Calf Blood Compound (CFC) and Homeopathic Drug Induce Differentiation of Primary Human Skeletal Muscle Cells

Calf Blood Compound (CFC) and Homeopathic Drug Induce Differentiation of Primary Human Skeletal Muscle Cells

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

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