Adductor Tenotomy in the Management of Groin Pain in Athletes

Abstract

This study evaluates the efficacy of adductor longus tenotomy in athletes with chronic tendinopathy refractory to conservative management. In a retrospective case series we report our experience with 109 male athletes who underwent unilateral adductor tenotomy during the period 2000–2005, all of whom responded to a detailed questionnaire. The criterion for tenotomy was chronic adductor origin pain which prevented training or playing (Level 4), limited training or playing (Level 3), or affected performance (Level 2)and which had failed to respond to conservative management including rest, rehabilitation and/or local steroid injection. Level 1 performance is classified as optimal performance with no pain. 99 of the 109 patients (91%) reported improvement. Best results were achieved in patients with maximum discomfort preoperatively (Level 4) with 32 of 38 (84%) patients returning to Level 1 performance. In conclusion, adductor tenotomy in athletes with severely incapacitating pain (Level 3/4) which fails to respond to conservative management offers the best opportunity of returning to competitive sport.

Key words

tendinopathy - groin pain - athletes - adductor tenotomy

References

• 1 Ahumada LA, Ashruf S, Espinosa-de-los-Monteros A, Long JN, de la Torre JI, Garth WP, Vasconez LO. Athletic pubalgia: definition and surgical treatment.  Ann Plast Surg. 2005;  55 393-396
• 2 Akermark C, Johansson C. Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes.  Am J Sports Med. 1992;  20 640-643
• 3 Atkinson HD, Johal P, Falworth MS, Ranawat VS, Dala-Ali B, Martin DK. Adductor tenotomy: its role in the management of sports-related chronic groin pain.  Arch Orthop Trauma Surg. 2009;  DOI 10.1007/s00402-009-1032-4 [Epub ahead of print]
• 4 Bradshaw CJ, Bundy M, Falvey E. The diagnosis of longstanding groin pain: a prospective clinical cohort study.  Br J Sports Med. 2008;  42 551-554
• 5 Brannigan AE, Kerin MJ, McEntee GP. Gilmore's groin repair in athletes.  J Orthop Sports Phys Ther. 2000;  30 329-332
• 6 Ekberg O, Persson NH, Abrahamsson PA, Westlin NE, Lilja B. Longstanding groin pain in athletes. A multidisciplinary approach.  Sports Med. 1988;  6 56-61
• 7 Harmon KG. Evaluation of groin pain in athletes.  Curr Sports Med Rep. 2007;  6 354-361
• 8 Harriss DJ, Atkinson G. International Journal of Sports Medicine – Ethical Standards in Sport and Exercise Science Research.  Int J Sports Med. 2009;  30 701-702
• 9 Holmich P. Long-standing groin pain in sportspeople falls into three primary patterns, a “clinical entity” approach: a prospective study of 207 patients.  Br J Sports Med. 2007;  41 247-252; discussion 252
• 10 Holmich P, Uhrskou P, Ulnits L, Kanstrup IL, Nielsen MB, Bjerg AM, Krogsgaard K. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial.  Lancet. 1999;  353 439-443
• 11 LeBlanc KE, LeBlanc KA. Groin pain in athletes.  Hernia. 2003;  7 68-71
• 12 Lynch SA, Renstrom PA. Groin injuries in sport: treatment strategies.  Sports Med. 1999;  28 137-144
• 13 Macintyre J, Johson C, Schroeder EL. Groin pain in athletes.  Curr Sports Med Rep. 2006;  5 293-299
• 14 Martens MA, Hansen L, Mulier JC. Adductor tendinitis and musculus rectus abdominis tendopathy.  Am J Sports Med. 1987;  15 353-356
• 15 Nicholas SJ, Tyler TF. Adductor muscle strains in sport.  Sports Med. 2002;  32 339-344
• 16 Renstrom P, Peterson L. Groin injuries in athletes.  Br J Sports Med. 1980;  14 30-36
• 17 Schilders E, Bismil Q, Robinson P, O’Connor PJ, Gibbon WW, Talbot JC. Adductor-related groin pain in competitive athletes. Role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections.  J Bone Joint Surg Am. 2007;  89 2173-2178
• 18 Topol GA, Reeves KD. Regenerative injection of elite athletes with career-altering chronic groin pain who fail conservative treatment: a consecutive case series.  Am J Phys Med Rehabil. 2008;  87 890-902
• 19 Topol GA, Reeves KD, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain.  Arch Phys Med Rehabil. 2005;  86 697-702

Correspondence