Adductor longus tendon release relieved groin pain in 87% of patients

Soccer and hockey players can usually return to sport about six to eight weeks after the procedure.

Issue: October 2005

AOSSM icon [photo] KEYSTONE, Colo. — An outpatient adductor longus release procedure helped resolve athletes’ chronic groin pain and quickly returned them to sport, investigators said.

“This is a very simple procedure. I think it’s fairly safe and we were not able to demonstrate loss of strength after the release,” said Bertram Zarins, MD, who is at Massachusetts General Hospital in Boston. “The key indication is identifying tenderness near the origin of the adductor longus tendon and pain with resisted adduction of the thigh.”

During the American Orthopaedic Society for Sports Medicine 2005 Annual Meeting here, Zarins presented results with the technique, which he learned from Ramon Cugat, MD, of Barcelona. Cugat is associate editor of Orthopaedics Today International.

Zarins operated on 15 patients who had groin pain near the origin of the adductor longus tendon; seven were affected bilaterally (mean age, 26 years old; range, 17 to 56 years). “Most of the patients had sustained a sprain-type injury to the adductor longus tendon; chronic pain persisted and did not respond to conservative measures. The pain prevented them from going back to sports,” he said.

During releases of the adductor longus tendon that he does, Dr. Cugat makes an incision in the patient’s groin skin fold that is about 2 to 3 cm long.

This photograph shows how the adductor longus tendon was retracted and the common femoral fascia was opened longitudinally.

Courtesy of Ramon Cugat

Among the inclusion criteria: groin pain originating below the inguinal ligament, adductor longus tenderness, pain with adduction and failed conservative treatment. Zarins told Orthopedics Today he usually prescribes several weeks of conservative treatment to confirm the diagnosis. “Dr. Cugat’s a bit more aggressive. In his experience, if pain has not cleared in three weeks, it probably will not resolve with more time. We tend to wait a bit longer. But, at whatever point conservative treatment has failed, if tenderness persists at the origin of the adductor longus tendon, and if the patient has pain with resisted tension on the tendon, releasing the tendon will probably have success.”

Cugat typically palpates the tendon and then cuts it with a knife blade close to its bone anchorage.

For the surgery, Zarins placed the patient’s legs in a spread position so the tendon was tensioned at about 90° adduction. He made a small incision, palpated the tendon and released it using a knife blade. “The key is to take your finger and push [the tendon] down distally so it retracts quite a bit. Otherwise, the adductor longus may reattach.”

Zarins warned those interested in doing the procedure to avoid the obturator nerve. “If you only cut what’s under tension, you’re okay.”

Stretch area postoperatively

Postoperatively, he cut down a triangular hip abduction pillow and strapped it in place between the patients’ legs, which they used continually for two or three days to stretch out the treated area. After that, they wore it occasionally, usually when sleeping.

At a minimum two-year follow-up, 13 patients (87%) reported good or excellent results with complete resolution of their symptoms. They returned to normal activity with no muscle weakness; their return to sport averaged 10 weeks.

One patient whose procedure failed underwent a herniorrhaphy.

Although Zarins diagnoses the condition in his professional athletes with MRI, he does not recommend it since the problem rarely shows up on the scans.

For more information:
Gill TJ, Nuccion S, Zarins B. Release of the adductor longus tendon for the treatment of groin pain in athletes. Presented at the American Orthopaedic Society for Sports Medicine 2005 Annual Meeting. July 14-17, 2005. Keystone, Colo.