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Int J Sports Med 2011; 32(1): 45-48
DOI: 10.1055/s-0030-1263137
Orthopedics & Biomechanics

© Georg Thieme Verlag KG Stuttgart · New York

Adductor Tenotomy in the Management of Groin Pain in Athletes

I. J. Robertson1 , C. Curran1 , N. McCaffrey2 , C. J. Shields1 , G. P. McEntee1
  • 1Department of Surgery, Mater Misericordiae Hospital, Dublin, Ireland
  • 2School of Health and Human Performance, Dublin City University, Dublin, Ireland
Further Information

Publication History

accepted after revision July 21, 2010

Publication Date:
25 November 2010 (online)

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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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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]
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 5 Brannigan AE, Kerin MJ, McEntee GP. Gilmore's groin repair in athletes.  J Orthop Sports Phys Ther. 2000;  30 329-332
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 7 Harmon KG. Evaluation of groin pain in athletes.  Curr Sports Med Rep. 2007;  6 354-361
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 11 LeBlanc KE, LeBlanc KA. Groin pain in athletes.  Hernia. 2003;  7 68-71
    CrossrefPubMedGoogle Scholar
  • 12 Lynch SA, Renstrom PA. Groin injuries in sport: treatment strategies.  Sports Med. 1999;  28 137-144
    CrossrefPubMedGoogle Scholar
  • 13 Macintyre J, Johson C, Schroeder EL. Groin pain in athletes.  Curr Sports Med Rep. 2006;  5 293-299
    PubMedGoogle Scholar
  • 14 Martens MA, Hansen L, Mulier JC. Adductor tendinitis and musculus rectus abdominis tendopathy.  Am J Sports Med. 1987;  15 353-356
    CrossrefPubMedGoogle Scholar
  • 15 Nicholas SJ, Tyler TF. Adductor muscle strains in sport.  Sports Med. 2002;  32 339-344
    CrossrefPubMedGoogle Scholar
  • 16 Renstrom P, Peterson L. Groin injuries in athletes.  Br J Sports Med. 1980;  14 30-36
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

Correspondence

Dr. Ian J. Robertson

Department of Surgery

Mater Misericordiae Hospital

Eccles Street

Dublin 7

Ireland

Phone: +35/38/7648 6092

Fax: +35/38/7648 6092

Email: irobertson@rcsi.ie

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