Surgical Release of the Adductor Longus With or Without Sports Hernia Repair Is a Useful Treatment for Recalcitrant Groin Strains in the Elite Athlete

Abstract

Background: Chronic strain and/or tendinopathy of the adductor longus tendon can be a cause of long-standing groin pain in the elite athlete, resulting in significant time lost from competition. Accurate diagnosis and treatment can expedite return to play. Purpose/Hypothesis: To evaluate return to sport and performance in National Collegiate Athletic Association (NCAA) Division I football players and National Football League (NFL) players following adductor longus release with or without sports hernia repair. We hypothesized that adductor release will be an effective method of treatment for recalcitrant groin/adductor pain in these athletes. Study Design: Case series; Level of evidence, 4. Methods: A cohort study was performed of all NFL players and NCAA Division I college athletes who had undergone an adductor longus tendon release with or without sports hernia repair by 1 of 2 fellowship-trained orthopaedic surgeons between May 1999 and January 2013. All patients reported groin pain below the inguinal ligament and localized to their adductor longus. Symptoms lasted longer than 10 weeks and limited their ability to effectively perform during sport, as assessed by their coach and self-assessment. Questionnaires were given to all 26 patients to assess long-term surgical outcomes. A subgroup analysis was performed for NFL players, in which “performance scores” were calculated according to individual player statistics while playing. Scores obtained before the diagnosis of chronic adductor longus tendinopathy or strain were compared with those after surgery. Patients with prior abdominal or pelvic surgery, radiographic evidence of degenerative joint disease of the hip, labral tears or femoral acetabular impingement, prostatic or urinary tract disease, or nerve entrapment of the ilioinguinal, genitofemoral, or lateral femoral cutaneous nerves were excluded from the study. Results: A total of 32 athletes underwent an adductor longus tenotomy during the study period. Of these patients, 28 were college- or professional-level athletes who underwent an adductor longus tenotomy, with a mean ± SD follow-up time of 6.2 ± 4.2 years (range, 12-178 months). Of the 32 patients, 20 had a concomitant sports hernia repair in addition to an adductor longus tenotomy. Thirty-one patients (97%) were able to return to their previous sport, and 30 (94%) were able to return at their previous level of play. Thirty patients (94%) reported that they were satisfied with their decision to have surgery. No player complained of weakness or a decrease in running speed or power. Mean return to play was 12 weeks from date of surgery. In the subgroup analysis of 16 NFL players, there were no statistically significant differences for the pre- versus postoperative comparisons of the athlete performance scores ( P = .74) and the percentage of the games started versus played ( P = .46). After separation of players who had a concomitant hernia repair from players who did not, there was no statistically significant difference in performance scores or percentages of games started. Conclusion: In this study of elite athletes, adductor longus tenotomy with or without a concomitant sports hernia repair provided overall acceptable and excellent results. Athletes were able to return to their previous level of athletic competition and performance with consistent relief of groin pain. Return to play in an NFL game averaged 12 weeks following surgery.

High Return to Play Rate and Reduced Career Longevity Following Surgical Management of Athletic Pubalgia in National Basketball Association Players

“…There is conflicting evidence in the literature regarding game use and performance following surgical treatment of AP in professional sports. 15,17,25 Jack et al 25 compared 56 NFL players who underwent surgical treatment of AP to a control group, finding that those in the surgery group played in significantly fewer seasons (3.8 AE 2.4 vs 3.2 AE 2.1 years) and GPS (14.0 AE 2.3 vs 12.0 AE 3.4) after RTP; however, they found no difference in performance between groups. 25 A retrospective review of NFL combine participants (mean age 22.1 years old) with a history of surgical treatment for AP was conducted by Knapik et al, 17 who found no significant impact on GPS, GS, draft status, roster activity, or number of seasons played.…”

Endoscopic Repair of Proximal Adductor Avulsion

“…Although the adductor complex has been surgically addressed in comprehensive open surgeries for athletic pubalgia (or core muscle injury), a recent study reports similar successful outcomes in afflicted athletes using surgery "targeted" to ENDOSCOPIC REPAIR OF PROXIMAL ADDUCTOR AVULSION e3 the specific pathologic area such as the adductor origin. 5 But if, for example, a pubic plate avulsion is found on endoscopic examination, endoscopic repair has been described 8 and can be performed seamlessly with endoscopic adductor repair. Furthermore, recalcitrant femoroacetabular impingement and osteitis pubis, which may occur concomitantly, may be addressed with hip arthroscopy for the former and endoscopic pubic symphysectomy 7 for the latter condition.…”

“…1 Good outcomes have been reported with conservative and surgical treatments. [2][3][4] In contrast to relatively common adductor tendinopathies which, when recalcitrant and treated surgically with tenotomy (partial or complete), 5 retracted avulsion injuries have been treated with open repair of the retracted tendon using suture anchor fixation. 3,4 This Technical Note presents a completely endoscopic reattachment of a severe grade 3 proximal adductor avulsion with >3 cm retraction (Fig 1) at 6 weeks after acute eccentric injury.…”

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

“…Players sustaining adductor muscle injuries and matched controls were identified using publicly available injury data via previously established methods. 8,9,[11][12][13][14][15][16][17]31 Sources for injury reports included official team websites, injury reports, official team press releases, personal websites, and professional statistical websites. Injury reports from public media platforms were manually cross-referenced with official league reports by 2 authors (O.L.-G. and S.P.).…”