Alexandra Dimitrakopoulou

Effectiveness of a Selective Partial Adductor Release for Chronic Adductor-Related Groin Pain in Professional Athletes

Background: Chronic adductor enthesopathy is a well-known cause of groin pain in athletes. Currently, percutaneous nonselective adductor tenotomies give mixed results and not always predictable outcomes. Hypothesis: A selective partial adductor longus release as treatment for recalcitrant chronic adductor longus enthesopathy provides excellent pain relief with a prompt and consistent return to preinjury levels of sport. Study Design: Case series; Level of evidence, 4. Methods: All athletes were assessed in a standard way for adductor dysfunction. They received radiographs and a specifically designed magnetic resonance imaging groin study protocol. Only professional athletes who received a selective partial adductor release were included. Pain and functional improvement were assessed with the visual analog scale (VAS) pain score and time to return to sport. Results: Forty-three professional athletes (39 soccer and 4 rugby) with chronic adductor-related groin pain were treated with a selective partial adductor release. The average follow-up time was 40.2 months (range, 25-72 months). Forty-two of 43 athletes returned to their preinjury level of sport after an average of u20099.21 weeks (range, 4-24 weeks; SD, 4.68 weeks). The preoperative VAS score improved significantly (Wilcoxon signed-rank test, P < .001) from 5.76 ± 1.08 (range, 3-8) to 0.23 ± 0.61 (range, 0-3) postoperatively. Conclusion: A selective partial adductor longus release provides excellent pain relief for chronic adductor enthesopathy in professional athletes with a consistent high rate of return to the preinjury level of sport.

Acute Avulsion of the Fibrocartilage Origin of the Adductor Longus in Professional Soccer Players: A Report of Two Cases

Acute ruptures of the adductor tendons are uncommon injuries. Although most adductor injuries occur at the musculotendinous junction proximally, case reports have described injuries occasionally occurring at the proximal and distal aspects of the adductor longus. Acute tears of the adductor longus at the origin are extremely rare; only 3 cases have been reported. Acute avulsion of its origin through its fibrocartilagenous enthesis has not been previously described in the literature. It occurs most commonly in vigorous and uncoordinated sporting activity, such as soccer, football, ice hockey, and Australian rules football. The purpose of this article is to describe an avulsed injury with noncontact mechanism, to discuss the particular anatomy of the adductor longus origin, and to report the rehabilitation and functional outcome following an acute repair in elite players. Because in this special group this injury has the potential to be career threatening, an adequate reduction and secure fixation of the avulsed fibrocartilage enthesis of the adductor longus is necessary.

The pyramidalis-anterior pubic ligament-adductor longus complex (PLAC) and its role with adductor injuries: a new anatomical concept.

PurposeAdductor longus injuries are complex. The conflict between views in the recent literature and various nineteenth-century anatomy books regarding symphyseal and perisymphyseal anatomy can lead to difficulties in MRI interpretation and treatment decisions. The aim of the study is to systematically investigate the pyramidalis muscle and its anatomical connections with adductor longus and rectus abdominis, to elucidate injury patterns occurring with adductor avulsions.MethodsA layered dissection of the soft tissues of the anterior symphyseal area was performed on seven fresh-frozen male cadavers. The dimensions of the pyramidalis muscle were measured and anatomical connections with adductor longus, rectus abdominis and aponeuroses examined.ResultsThe pyramidalis is the only abdominal muscle anterior to the pubic bone and was found bilaterally in all specimens. It arises from the pubic crest and anterior pubic ligament and attaches to the linea alba on the medial border. The proximal adductor longus attaches to the pubic crest and anterior pubic ligament. The anterior pubic ligament is also a fascial anchor point connecting the lower anterior abdominal aponeurosis and fascia lata. The rectus abdominis, however, is not attached to the adductor longus; its lateral tendon attaches to the cranial border of the pubis; and its slender internal tendon attaches inferiorly to the symphysis with fascia lata and gracilis.ConclusionThe study demonstrates a strong direct connection between the pyramidalis muscle and adductor longus tendon via the anterior pubic ligament, and it introduces the new anatomical concept of the pyramidalis–anterior pubic ligament–adductor longus complex (PLAC). Knowledge of these anatomical relationships should be employed to aid in image interpretation and treatment planning with proximal adductor avulsions. In particular, MRI imaging should be employed for all proximal adductor longus avulsions to assess the integrity of the PLAC.

Current concepts of inguinal-related and adductor-related groin pain.

Groin pain encompasses a number of conditions from the lower abdomen, inguinal region, proximal adductors, hip joint, upper anterior thigh and perineum. The complexity of the anatomy, the heterogeneous terminology and the overlapping symptoms of different conditions that may co-exist epitomise the challenges in diagnosis and treatment. Inguinal-related and adductor-related pain is the most common cause of groin pain and will be discussed in this article.

Focal osteopenia of pubic parasymphyseal bone as an underlying cause of groin pain in sports: a new perspective

Groin pain is a common problem in athletes. The diagnosis can be difficult because of the complexity of the groin anatomy, the numerous clinical entities presenting with similar symptoms, the concurrence of those entities and the confusing terminology. Thus, a dilemma in diagnosis may arise leading to long-standing symptoms, disabling groin pain, mismanagement and therefore to poor treatment. Hereby, we present such a case of a recreational athlete complaining for excruciate pubic pain after being misdiagnosed and subsequently mistreated affecting her quality of life. We report on a new interesting finding, the focal osteopenia over the pubic parasymphyseal bone, together with administration of bisphosphonates for first time, as a treatment, for this condition in this body area. Our purpose is to shed light on the pathomechanism of groin pain labelled as osteitis pubis. We also outline the importance of thorough history and physical examination combined with appropriate advanced imaging.

The Painful Groin

The painful groin is a challenging entity. It is a common problem in sports with incidence 5–18 % and is most prevalent in sports which involve kicking and sprinting with rapid changes of direction. The adductor longus is the most common pathology causing long-standing problems.

Surgical Treatment of Specific Hip Conditions: Ligamentum Teres Injuries

Injury to the ligamentum teres has been recognised as a source of persistent hip pain and it is known as a result of major trauma or dislocation of the hip joint. Recently, as hip arthroscopy has been advanced, we gained a greater understanding of the ligament. Imaging modalities have been improved to visualise the ligament, but specific tests to diagnose a torn ligament during clinical examination are still lacking. Partial tears, degenerate or complete rupture of ligamentum teres can be easily identified during arthroscopic surgery.

Ligamentum Teres: Anatomy, Structure and Function

Advances in hip arthroscopy along with the improvements in surgical techniques and imaging modalities have enhanced our knowledge of the hip joint. Pathology of the femoral head and the acetabulum as well as the soft tissues of the hip joint can be readily diagnosed.