Ultrasound-Guided Cutting Wire Release of the Proximal Adductor Longus Tendon: A Feasibility Study

Abstract

Background: Adductor longus tendinopathy is a well-known etiology of chronic groin pain in elite athletes. Surgery is indicated for those who fail conservative treatment. No studies to date have evaluated the feasibility of an ultrasound-guided release of the proximal adductor longus tendon. Purpose/Hypothesis: The primary aim of this study was to determine the feasibility of an ultrasound-guided selective adductor longus release with a cutting wire. A secondary aim was to determine safety by avoiding injury to adjacent structures. We hypothesized that the proximal adductor longus tendon can be released under ultrasound guidance with a cutting wire without injury to adjacent neurovascular or genitourinary structures. Study Design: Descriptive laboratory study. Methods: Ten adductor longus tendons (5 cadaveric specimens) from 4 males and 1 female between 76 and 89 years of age with a mean body mass index of 21.9 kg/m2 (range, 16.8-29.6 kg/m2) were used during this study. A single experienced physician sonographer performed ultrasound-guided proximal adductor longus tendon releases on all cadaveric specimens using a cutting wire. Dissection was performed by a second physician to determine the completeness of the tendon transections and to detect injury to adjacent neurovascular or genitourinary structures. Results: All 10 adductor longus tendons were transected. Eight of 10 transections were complete, whereas in 2 transections, >99% of the tendon was transected. There were no injuries to adjacent genitourinary or neurovascular structures. Conclusion: Ultrasound-guided adductor tendon release is feasible and safe in a cadaveric model. Further translational research should be performed to determine whether these results can be replicated in the clinical setting. Clinical Relevance: Adductor longus tendinopathy frequently requires surgical intervention and prolonged time away from sport. The present study suggests that a selective adductor longus tendon release can be performed with ultrasound guidance. This procedure warrants further translational research to explore its use in clinical practice.

Ultrasound‐Guided Cutting Wire Release of the Posterior Iliotibial Band: A Feasibility Study

“…Prior cadaveric and clinical investigations have demonstrated that USG cutting wire releases for carpal tunnel syndrome and trigger fingers are safe and effective 15,16,21–23 . We recently completed a study demonstrating the feasibility of an USG adductor longus tendon release using a cutting wire 14 . The current study supports the prior findings that a cutting wire can be used to perform an accurate, safe, efficient, and relatively simple USG release.…”

“…Initially, US was used for simple procedures, such as USG joint, bursa, and tendon sheath injections. More recently, advanced needle based procedures (eg, needle tenotomy) and USG surgical procedures (compartment fasciotomies, ultrasonic tendon debridement, carpal tunnel releases, adductor longus releases, long head of the biceps tendon releases) have been introduced into orthopedic and sports medicine settings 13–19 . USG procedures may offer the benefit of lower risk, less pain, quicker recovery, and lower cost when compared to open surgical procedures 20 .…”

Minimally invasive ultrasound‐assisted cutting thread tenotomy of the deep digital flexor tendon in horses: An ex vivo study

“…However, damage was not reported after using the cutting thread technique as both structures are adjacent and the artery is easy to identify with ultrasound. 17 Similarly, no medial palmar nerves were damaged in the final 10 specimens when compared to two in the first 10 limbs, where only a palmar ultrasonographic window was used. 18 With regard to lateral palmar nerve damage (4/20 damaged), the addition of the palmaro-lateral window did not prevent injury as one nerve was transected in the first 10 limbs and three in the last 10.…”

“…This is in agreement with human studies, where ligament, fascia or tendons are always reliably cut using the cutting thread technique. [14][15][16][17][18] In contrast, a recent study in horses revealed that the annular ligament was not completely severed in 4/21 horses. 19 Failures were attributed to technique errors or the difficulty of imaging the thin annular ligament properly during the procedure.…”

“…14,15 Thread carpal tunnel release (TCTR) by desmotomy of the transverse carpal ligament (TCL) is currently performed clinically with this technique and thread superficial peroneal nerve release (TSPNR) using a crural fasciotomy, and proximal adductor longus tenotomy has been investigated ex vivo. [15][16][17] Thread carpal tunnel release was safe, well tolerated, it prevented damage to other structures, and reduced the severity of symptoms and dysfunction associated with carpal tunnel syndrome effectively. 15,18 Based on this information, a cutting thread technique has been applied for annular ligament desmotomy in horses and it could also be applied for DDFT tenotomy.…”