Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2016

09.06.2015 | Sports Medicine

Nonoperative treatment and return to play after complete proximal adductor avulsion in high-performance athletes

verfasst von: Peter Ueblacker, Bryan English, Hans-Wilhelm Mueller-Wohlfahrt

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 12/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To assess the outcome of nonoperative treatment after complete avulsion of the proximal adductor longus tendon in high-performance athletes.

Methods

Six consecutive athletes were included. Treatment was conservative following a strict rehabilitation plan. Following parameters were analysed: basic data, mechanism of injury, classification, tendon retraction, size of defect in MRI and return to play (RTP).

Results

Mean age at injury was 28 ± 5 (range 20–32) years. Overstretch (83 %) and kicking (50 %) were the most frequent injury mechanisms, and the dominant leg was involved in 83 %. Average retraction of the avulsed tendon amounted 21 ± 5 mm. Follow-up MRIs demonstrated a gradual reattachment of the tendon in all cases. All athletes returned to full sportive activity on preinjury level within 88.7 ± 12.8 (range 75–110) days with no functional deficiencies. Manual muscle strength was equal to the contralateral side.

Conclusion

Nonoperative treatment with a healing phase and a strict rehabilitation plan results in a functional, efficient reattachment of the tendon and allows unrestricted RTP. Since these injuries are rare, present study may help sports physicians when dealing with this type of injuries in professional athletes. Return to sports can be expected at approximately 13 weeks after injury, but can take even longer.

Level of evidence

Case series, Level IV.
Literatur
1.
Zurück zum Zitat Akermark C, Johansson C (1992) Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. Am J Sports Med 20(6):640–643CrossRefPubMed Akermark C, Johansson C (1992) Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. Am J Sports Med 20(6):640–643CrossRefPubMed
2.
Zurück zum Zitat Cohen S, Bradley J (2007) Acute proximal hamstring rupture. J Am Acad Orthop Surg 15(6):350–355CrossRefPubMed Cohen S, Bradley J (2007) Acute proximal hamstring rupture. J Am Acad Orthop Surg 15(6):350–355CrossRefPubMed
3.
Zurück zum Zitat Delahunt E, Kennelly C, McEntee BL, Coughlan GF, Green BS (2011) The thigh adductor squeeze test: 45 degrees of hip flexion as the optimal test position for eliciting adductor muscle activity and maximum pressure values. Man Ther 16(5):476–480CrossRefPubMed Delahunt E, Kennelly C, McEntee BL, Coughlan GF, Green BS (2011) The thigh adductor squeeze test: 45 degrees of hip flexion as the optimal test position for eliciting adductor muscle activity and maximum pressure values. Man Ther 16(5):476–480CrossRefPubMed
4.
Zurück zum Zitat Dimitrakopoulou A, Schilders EM, Talbot JC, Bismil Q (2008) Acute avulsion of the fibrocartilage origin of the adductor longus in professional soccer players: a report of two cases. Clin J Sport Med 18(2):167–169CrossRefPubMed Dimitrakopoulou A, Schilders EM, Talbot JC, Bismil Q (2008) Acute avulsion of the fibrocartilage origin of the adductor longus in professional soccer players: a report of two cases. Clin J Sport Med 18(2):167–169CrossRefPubMed
5.
Zurück zum Zitat Ekstrand J, Hilding J (1999) The incidence and differential diagnosis of acute groin injuries in male soccer players. Scand J Med Sci Sports 9(2):98–103CrossRefPubMed Ekstrand J, Hilding J (1999) The incidence and differential diagnosis of acute groin injuries in male soccer players. Scand J Med Sci Sports 9(2):98–103CrossRefPubMed
6.
Zurück zum Zitat Garcia VV, Duhrkop DC, Seijas R, Ares O, Cugat R (2012) Surgical treatment of proximal ruptures of the rectus femoris in professional soccer players. Arch Orthop Trauma Surg 132(3):329–333CrossRefPubMed Garcia VV, Duhrkop DC, Seijas R, Ares O, Cugat R (2012) Surgical treatment of proximal ruptures of the rectus femoris in professional soccer players. Arch Orthop Trauma Surg 132(3):329–333CrossRefPubMed
7.
Zurück zum Zitat Hagglund M, Walden M, Ekstrand J (2005) Injury incidence and distribution in elite football-a prospective study of the Danish and the Swedish top divisions. Scand J Med Sci Sports 15(1):21–28CrossRefPubMed Hagglund M, Walden M, Ekstrand J (2005) Injury incidence and distribution in elite football-a prospective study of the Danish and the Swedish top divisions. Scand J Med Sci Sports 15(1):21–28CrossRefPubMed
8.
Zurück zum Zitat Hagglund M, Walden M, Ekstrand J (2006) Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. Br J Sports Med 40(9):767–772CrossRefPubMedPubMedCentral Hagglund M, Walden M, Ekstrand J (2006) Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. Br J Sports Med 40(9):767–772CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Harris JD, Griesser MJ, Best TM, Ellis TJ (2011) Treatment of proximal hamstring ruptures—a systematic review. Int J Sports Med 32(7):490–495CrossRefPubMed Harris JD, Griesser MJ, Best TM, Ellis TJ (2011) Treatment of proximal hamstring ruptures—a systematic review. Int J Sports Med 32(7):490–495CrossRefPubMed
10.
Zurück zum Zitat Hawkins RD, Fuller CW (1999) A prospective epidemiological study of injuries in four English professional football clubs. Br J Sports Med 33(3):196–203CrossRefPubMedPubMedCentral Hawkins RD, Fuller CW (1999) A prospective epidemiological study of injuries in four English professional football clubs. Br J Sports Med 33(3):196–203CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Hawkins RD, Hulse MA, Wilkinson C, Hodson A, Gibson M (2001) The association football medical research programme: an audit of injuries in professional football. Br J Sports Med 35(1):43–47CrossRefPubMedPubMedCentral Hawkins RD, Hulse MA, Wilkinson C, Hodson A, Gibson M (2001) The association football medical research programme: an audit of injuries in professional football. Br J Sports Med 35(1):43–47CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Hodgson L, Hignett T, Edwards K (2014) Normative adductor squeeze tests scores in rugby. Phys Ther Sport 16(2):93–97CrossRefPubMed Hodgson L, Hignett T, Edwards K (2014) Normative adductor squeeze tests scores in rugby. Phys Ther Sport 16(2):93–97CrossRefPubMed
13.
Zurück zum Zitat Lohrer H, Nauck T (2007) Proximal adductor longus tendon tear in high level athletes. A report of three cases. Sportverletz Sportschaden 21(4):190–194CrossRefPubMed Lohrer H, Nauck T (2007) Proximal adductor longus tendon tear in high level athletes. A report of three cases. Sportverletz Sportschaden 21(4):190–194CrossRefPubMed
14.
Zurück zum Zitat Mei-Dan O, Lopez V, Carmont MR, McConkey MO, Steinbacher G, Alvarez PD, Cugat RB (2013) Adductor tenotomy as a treatment for groin pain in professional soccer players. Orthopedics 36(9):e1189–e1197CrossRefPubMed Mei-Dan O, Lopez V, Carmont MR, McConkey MO, Steinbacher G, Alvarez PD, Cugat RB (2013) Adductor tenotomy as a treatment for groin pain in professional soccer players. Orthopedics 36(9):e1189–e1197CrossRefPubMed
15.
Zurück zum Zitat Mueller-Wohlfahrt HW, Haensel L, Mithoefer K, Ekstrand J, English B, McNally S, Orchard J, van Dijk CN, Kerkhoffs GM, Schamasch P, Blottner D, Swaerd L, Goedhart E, Ueblacker P (2013) Terminology and classification of muscle injuries in sport: the Munich consensus statement. Br J Sports Med 47(6):342–350CrossRefPubMed Mueller-Wohlfahrt HW, Haensel L, Mithoefer K, Ekstrand J, English B, McNally S, Orchard J, van Dijk CN, Kerkhoffs GM, Schamasch P, Blottner D, Swaerd L, Goedhart E, Ueblacker P (2013) Terminology and classification of muscle injuries in sport: the Munich consensus statement. Br J Sports Med 47(6):342–350CrossRefPubMed
16.
Zurück zum Zitat Mueller-Wohlfahrt HW, Ueblacker P, Haensel L, Garrett WE (2013) Muscle injuries in sports. Thieme, StuttgartCrossRef Mueller-Wohlfahrt HW, Ueblacker P, Haensel L, Garrett WE (2013) Muscle injuries in sports. Thieme, StuttgartCrossRef
17.
Zurück zum Zitat Peterson L, Renstrom P (2001) Sports injuries, 3rd edn. Martin Dunitz, London Peterson L, Renstrom P (2001) Sports injuries, 3rd edn. Martin Dunitz, London
18.
Zurück zum Zitat Peterson L, Stener B (1976) Old total rupture of the adductor longus muscle. A report of seven cases. Acta Orthop Scand 47(6):653–657CrossRefPubMed Peterson L, Stener B (1976) Old total rupture of the adductor longus muscle. A report of seven cases. Acta Orthop Scand 47(6):653–657CrossRefPubMed
19.
Zurück zum Zitat Quah C, Cottam A, Hutchinson J (2014) Surgical management of a completely avulsed adductor longus muscle in a professional equestrian rider. Case Rep Orthop. doi:10.1155/2014/828314 Quah C, Cottam A, Hutchinson J (2014) Surgical management of a completely avulsed adductor longus muscle in a professional equestrian rider. Case Rep Orthop. doi:10.​1155/​2014/​828314
20.
Zurück zum Zitat Rizio L 3rd, Salvo JP, Schurhoff MR, Uribe JW (2004) Adductor longus rupture in professional football players: acute repair with suture anchors: a report of two cases. Am J Sports Med 32(1):243–245CrossRefPubMed Rizio L 3rd, Salvo JP, Schurhoff MR, Uribe JW (2004) Adductor longus rupture in professional football players: acute repair with suture anchors: a report of two cases. Am J Sports Med 32(1):243–245CrossRefPubMed
21.
Zurück zum Zitat Sangwan SS, Aditya A, Siwach RC (1994) Isolated traumatic rupture of the adductor longus muscle. Indian J Med Sci 48(8):186–187PubMed Sangwan SS, Aditya A, Siwach RC (1994) Isolated traumatic rupture of the adductor longus muscle. Indian J Med Sci 48(8):186–187PubMed
22.
Zurück zum Zitat Schlegel TF, Bushnell BD, Godfrey J, Boublik M (2009) Success of nonoperative management of adductor longus tendon ruptures in National Football League athletes. Am J Sports Med 37(7):1394–1399CrossRefPubMed Schlegel TF, Bushnell BD, Godfrey J, Boublik M (2009) Success of nonoperative management of adductor longus tendon ruptures in National Football League athletes. Am J Sports Med 37(7):1394–1399CrossRefPubMed
23.
Zurück zum Zitat Schlumberger A (2013) Prevention of muscle injuries. In: Mueller-Wohlfahrt HW, Ueblacker P, Haensel L (eds) Muscle injuries in sports. Thieme, Stuttgart, pp 365–380 Schlumberger A (2013) Prevention of muscle injuries. In: Mueller-Wohlfahrt HW, Ueblacker P, Haensel L (eds) Muscle injuries in sports. Thieme, Stuttgart, pp 365–380
24.
Zurück zum Zitat Symeonides PP (1972) Isolated traumatic rupture of the adductor longus muscle of the thigh. Clin Orthop Relat Res 88:64–66CrossRefPubMed Symeonides PP (1972) Isolated traumatic rupture of the adductor longus muscle of the thigh. Clin Orthop Relat Res 88:64–66CrossRefPubMed
25.
Zurück zum Zitat Ueblacker P, Mueller-Wohlfahrt HW, Hinterwimmer S, Imhoff AB, Feucht MJ (2014) Suture anchor repair of proximal rectus femoris avulsions in elite football players. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3177-0 PubMed Ueblacker P, Mueller-Wohlfahrt HW, Hinterwimmer S, Imhoff AB, Feucht MJ (2014) Suture anchor repair of proximal rectus femoris avulsions in elite football players. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-014-3177-0 PubMed
26.
Zurück zum Zitat Vogt S, Ansah P, Imhoff AB (2007) Complete osseous avulsion of the adductor longus muscle: acute repair with three fiberwire suture anchors. Arch Orthop Trauma Surg 127(8):613–615CrossRefPubMed Vogt S, Ansah P, Imhoff AB (2007) Complete osseous avulsion of the adductor longus muscle: acute repair with three fiberwire suture anchors. Arch Orthop Trauma Surg 127(8):613–615CrossRefPubMed
27.
Zurück zum Zitat Walden M, Hagglund M, Ekstrand J (2005) UEFA Champions League study: a prospective study of injuries in professional football during the 2001–2002 season. Br J Sports Med 39(8):542–546CrossRefPubMedPubMedCentral Walden M, Hagglund M, Ekstrand J (2005) UEFA Champions League study: a prospective study of injuries in professional football during the 2001–2002 season. Br J Sports Med 39(8):542–546CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Werner J, Hagglund M, Walden M, Ekstrand J (2009) UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 43(13):1036–1040CrossRefPubMed Werner J, Hagglund M, Walden M, Ekstrand J (2009) UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 43(13):1036–1040CrossRefPubMed
Metadaten
Titel
Nonoperative treatment and return to play after complete proximal adductor avulsion in high-performance athletes
verfasst von
Peter Ueblacker
Bryan English
Hans-Wilhelm Mueller-Wohlfahrt
Publikationsdatum
09.06.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 12/2016
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3669-6

Weitere Artikel der Ausgabe 12/2016

Knee Surgery, Sports Traumatology, Arthroscopy 12/2016 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.