Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes

Abstract

Eighteen tenotomies of the adductor longus tendon were performed in 16 consecutive male athletes (aged 20 to 42) as treatment for chronic groin pain. The criteria for surgery was a history of long-standing (range, 2.5 to 48 months) and distinct pain at the origin of the adductor longus muscle, refractory to conservative treatment. At followup 35 months (range, 4 to 84) after surgery, all patients were improved or free of symptoms. All but 1 of the athletes returned to the same sport within a mean of 6.6 weeks, and 12 of 16 returned to competitive sports within a mean of 14 weeks after surgery. A majority of the patients (10 of 16) returned to full athletic activity, whereas 5 of 16 performed at a reduced level. One patient discontinued his sports activity due to other causes. In conclusion, when conservative treatment fails, tenotomy of the adductor longus tendon gives good long-term functional results in the treatment of chronic groin pain that is localized at the origin of the adductor longus muscle. A decreased muscle strength was observed in this study and did not seem to influence participation in sports.

Understanding “Sports Hernia” (Athletic Pubalgia): The Anatomic and Pathophysiologic Basis for Abdominal and Groin Pain in Athletes

“…The various loosening operations [75,76] -adductor releases, etc -do not require stabilizing time, and time for return to game activity in general may be shorter. However, the surgical pain resolution may vary and take at least several weeks.…”

Proposed Algorithm for the Management of Athletes With Athletic Pubalgia (Sports Hernia): A Case Series

“…40,48,50,53,58,63 If there is preoperative involvement of the adductor longus tendon, the surgeon may opt to concurrently perform an adductor tenotomy-typically fractional lengthening. 1,2,5,50,53,58,80 The increasingly common laparoscopic procedure involves preperitoneal insertion of a polypropylene mesh, 1,22,39,46,63,74,80 resulting in less postoperative pain, smaller incisions, faster recovery rate, and has the additional advantage in that a diagnostic scope can be immediately followed by the repair. 46,61,80 Early outcome studies utilizing laparoscopic repair indicate high success in rates of return to preinjury level of play within 3 to 6 months.…”

Patient with Groin Pain After an Athletic Event

“…While small series of laparoscopic and open repair have provided encouraging results, a multicenter prospective randomized controlled trial is needed. [ 4 ] 28 96 50 % Open mesh 50 % Laparoscopic mesh Paajanen [ 16 ] 41 95 TEP Genitsaris [ 17 ] 131 97 TAPP Topol [ 12 ] 24 92 Pubic symphysis/adductor injection Akermark [ 13 ] 16 62 Adductor tenotomy…”

“…For those who fail conservative management of osteitis pubis and/or adductor tendinopathy, periodic injections of the pubic cleft and adductor origin with dextrose and lidocaine have been effective for resolution of chronic pain [ 11 , 12 ]. In a small subset of athletes who fail these nonoperative measures, adductor tenotomy (surgical release of the adductor longus tendon at its origin from the pubis) has provided encouraging long-term symptomatic and functional results [ 13 ].…”