Proximal Adductor Avulsion Injuries: Outcomes of Surgical Reattachment in Athletes

Abstract

Background:Sports-related groin injuries are common among athletes. However, traumatic proximal adductor avulsion injuries are relatively rare groin injuries in the athletic population, with limited case reports describing suture anchor repair.Purpose:To report on the outcomes of surgical reattachment of proximal adductor avulsion injuries in athletes utilizing a suture anchor repair technique.Study Design:Case series; Level of evidence, 4.Methods:Prospective data were collected on patients undergoing surgical reattachment of proximal adductor avulsion injuries from December 2012 to May 2015 by a single surgeon. Six athletes presented after a traumatic sports-related injury with disabling groin pain, adductor weakness, and magnetic resonance imaging confirmation of fibrocartilage avulsion of the proximal adductor with retraction. Patient-reported outcomes (Hip Outcome Score–Activities of Daily Living [HOS-ADL] and Hip Outcome Score–Sport Specific [SS] subscales, modified Harris Hip Score [mHHS], and visual analog scale [VAS] for pain) were collected preoperatively and at a minimum 2-year follow-up.Results:The latest follow-up of each patient averaged 33.4 months postoperatively (range, 25-42.5 months). All patients returned to sporting activities, with 1 minor wound complication that resolved. Paired-samples t tests indicated that the mean latest postoperative scores for all patients were significantly better than their mean preoperative scores (HOS-ADL: 99.0 vs 43.2, HOS-SS: 98.9 vs 8.3, and mHHS: 97.1 vs 44.6, respectively; P < .001 for all). Similarly, there was a significant improvement in mean postoperative VAS scores for all patients (from 89.2 to 2.2; P < .001).Conclusion:Patient-reported outcomes offer an objective measure of hip function and pain control. Surgical reattachment utilizing a multiple suture anchor technique is a successful procedure that allows for a safe return to athletic performance and a predictable return to sport.

Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study

“…29 In comparison, case series on operative treatment have reported mean RTS durations of around 12 to 21 weeks. 3,18,26 The RTS duration for athletes with grade 0-2 adductor injuries in our study is comparable with a large epidemiological study of elite male European soccer players in which an average of 14 ± 6.2 days (range, 0-361 days) of absence from sport was reported. 7 In that study, 49% of injuries resulted in less than 7 days of absence.…”

“…29 In comparison, case series on operative treatment have reported mean RTS durations of around 12 to 21 weeks. 3,18,26…”

Endoscopic Repair of Proximal Adductor Avulsion

“…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.…”

Hip Adductor Longus Tendon Origin Anatomy Is Consistent and May Inform Surgical Reattachment

“…As this injury has become increasingly more recognized through greater understanding of injury patterns and improvements in diagnostic imaging modalities, 8 , 9 , 10 , 11 surgical repair of proximal avulsions has become more common. 12 , 13 Multiple case series have reported excellent outcomes and near-full recovery in athletic populations; however, this remains a controversial topic, with advocates for both operative and nonoperative management. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20…”

“… 12 , 13 Multiple case series have reported excellent outcomes and near-full recovery in athletic populations; however, this remains a controversial topic, with advocates for both operative and nonoperative management. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20…”