Adductor Injuries in Athletes: Evidence-Based Treatment.

Abstract

Adductor injuries represent a notable musculoskeletal burden among athletes accounting for half of acute hip injuries in soccer and nearly one quarter in professional basketball. The pyramidalis-anterior pubic ligament-adductor longus complex represents a critical anatomic concept for understanding injury patterns with the adductor longus most injured. Clinical evaluation follows the Doha agreement classification, emphasizing adductor tenderness and pain on resisted adduction testing to differentiate adductor-related groin pain from other etiologies. Magnetic resonance imaging provides comprehensive injury characterization, with validated classification systems predicting return-to-play timelines. Prevention strategies target modifiable risk factors including adductor weakness and reduced hip rotational range of motion, with strengthening programs demonstrating potential to reduce injury incidence. Nonsurgical management remains the cornerstone of treatment for most injuries with return to play averages 2 to 3 weeks for partial tears and 8 to 12 weeks for complete tears managed nonsurgically, although recurrence rates are as high as 19%. Surgical intervention is considered for acute avulsions with greater than 2 cm retraction or chronic injuries refractory to conservative treatment, although comparative evidence versus structured nonsurgical care is limited. Surgical management options include repair, partial tenotomy, or complete tenotomy. All three surgical approaches demonstrate good outcomes in nonrandomized cohort studies with return to play averaging 10 to 14 weeks and repair being favored for traumatic complete avulsion particularly in professional athletes.