Summary

Adductor tenotomy with or without sports hernia repair is an effective treatment for chronic groin pain in the elite athlete.

Abstract

Chronic strain and/or tendinopathy of the adductor longus tendon can be a cause of long standing groin pain in the elite athlete, resulting in significant time lost from competition. An accurate diagnosis and treatment plan can expedite return to play. Non-operative treatments are not always successful, and there is a lack of data regarding the outcome of adductor tenotomies for the treatment of chronic adductor longus pain in this patient population. The purpose of the study was to evaluate return to sport and performance in the college players and professional athletes in the National Football league following adductor longus release.

Methods

A retrospective review was performed of all NFL players and college athletes who had undergone an adductor longus tendon release by one of two fellowship trained orthopedic surgeons between May of 1999 and January of 2013. All patients reported groin pain below the inguinal ligament and localized to their adductor longus. Symptoms lasted greater than 10 weeks and led to a reduced ability or inability to perform their sport. Questionnaires were given to all patients to assess long-term surgical outcomes. A subgroup analysis was performed for the sixteen NFL players. For this subgroup, “performance scores” were calculated based on the individual players statistics while playing. Scores obtained prior to the diagnosis of chronic adductor longus tendinopathy or strain were compared to those after surgery. Patients with prior abdominal or pelvic surgery, radiographic evidence of degenerative joint disease of the hip, labral tears or femoral acetabular impingment, prostatic or urinary tract disease or nerve entrapment of the ilioinguinal, genitofemoral, or lateral femoral cutaneous nerves were excluded from the study.

Results

Thirty-two athletes underwent an adductor longus tenotomy during the study period. Twenty-eight of these patients were college or professional-level athletes who underwent an adductor longus tenotomy with an average follow up time of 6.2 ± 4.2 years (range 1.0 -14.8 years). Fifteen of the 28 patients had a concomitant sports hernia repair in addition to an adductor longus tenotomy. At follow-up, 27 patients (96.4%) reported a significant improvement in their symptoms, and twenty patients (71.4%) were completely asymptomatic at time of follow-up. Twenty-six patients (92.8%) were able to return to their previous level of play and 26 patients (92.8%) reported that they would have the surgery again. No player complained of weakness or decrease in running speed/power. Return to sport averaged 12 weeks following surgery.

In the sub group analysis of sixteen NFL players, there were no statistically significant differences for the pre-operative vs. post-operative comparison of the athlete performance scores (P= 0.98) and the percentage of games started versus games played (P=0.13). Patients with concomitant hernia repair did not have a significant difference in performance scores (P=0.66). There was a tend towards greater amount of games started vs. played post-operatively in patients with isolated adductor longus released compared to those with concomitant hernia repair (P=0.05).

Conclusions

In this study of elite athletes, adductor longus tenotomy with or without a concomitant sports hernia repair provided overall good and excellent results. Athletes were able to return to previous level of sports performance at an average of 12 weeks post-operatively.