PFATS Articles

Complete Proximal Adductor Longus Rupture in a Professional Football Player: A Case Study

Corey Oshikoya, M.Ed., ATC, Assistant Athletic Trainer, Denver Broncos

 

In recent years, sports medicine professionals have witnessed an increased rate of pelvic injuries and it is estimated that five percent of all sports injuries are related to the groin region.  This has been attributed to many factors including improved diagnostic tools, the cumulative effects of over-training and a greater understanding of core musculature. While the percentage of groin-related injuries in professional football has not been published, anecdotally professional football athletic trainers have seen a significant increase in athletes suffering from groin injuries as well.

With increased study, sports health professionals have determined that the adductor muscle group plays a significant role in the cause and resolution of groin/pelvic pathologies. The adductor muscle often suffers both micro and macro trauma in its attempt to provide stability to this region. Although uncommon, the proximal rupture/avulsion of the adductor muscle from its pubic attachment can cause significant problems if not properly assessed and treated.

Anatomy Basics
The adductor muscle group consists of three muscles.  The most anterior of the three is the adductor longus, followed by the brevis and the magnus. All three muscles originate from the inferior ramus of the pubis bone with the adductor magnus having additional attachments posteriorly to the ischial tuberosity. The distal insertions of these muscles are found along the medial shaft of the femur’s linea aspera, with the longus and the magnus having significantly broader insertions compared to their origins. The adductor muscles are innervated primarily by the obturator nerve with the magnus receiving some innervation from branches of the sciatic nerve. The principal function of the adductor muscle group is thigh adduction. The brevis and magnus contribute to hip flexion and part of the magnus also assists with hip extension.

Case Report
During the first quarter of a regular season football game, a 23-year-old rookie cornerback reported a groin injury. The athlete described a quick change of direction during a pass play in which he felt a “pop” and pain in the right groin.  The athlete was removed from the game for further evaluation and did not return to play.

The following day during an exam, the athlete stated that he felt his symptoms had improved overnight, but continued to have minor soreness in his lower right abdomen which persisted through normal daily activities.           

Physical exam findings:

• Point tenderness in the lower right lower abdomen and the origin of the right adductor group
• Symmetrical hip flexion and internal rotation
• 10 degree deficit in external rotation
• 40 degrees hip abduction from the midline
• Unable to conduct motor testing due to pain

The MRI reported three significant findings:

• Edema over the pubic symphysis
• A proximal strain to the adductor brevis muscle
• An avulsion of the proximal attachments of the adductor longus

The medical staff’s extensive experience with this type of injury lead them to recommend a non-surgical approach. The athlete participated in a rehabilitation program and progressed to sport-specific activities.

Rehabilitation
The rehabilitation program focused on progressing exercises based on pain-free range of motion. 
Week #1

• Pain management
• Bike/pool walking
• Platelet Rich Plasma (PRP) application
• Straight leg raise with sport cord
• Low level table core stabilization 

Week #2

• Straight leg raise (weight & sports cord)
• Ball core exercises
• Treadmill walking
• Functional sport cord (walk/run)
• Modified weight room program

      Week #3

• Slide board program
• Advanced core exercises
• Lower leg PNF (bent leg & straight leg)
• Treadmill running

      Week #4

• Continue treatment program
• Practice: scout team

      Week #5

• Participated in a maintenance program

      Week #6

• Return to participation

At week three of his rehabilitation program, the athlete stated that he felt fully recovered, so sport-specific drills were integrated into his rehabilitation sessions. In addition to his exercise program, platelet rich plasma was injected into the injury site to assist with healing.  Platelet rich plasma is constructed from a small sample of blood drawn from the athlete. This gel/plasma has a higher concentration of platelets and other growth factors, which naturally stimulate the repair and growth of normal cells and tissue. This technique has been introduced in oral surgery and is the underlying concept used in the micro-fracture operation for the repair of articular cartilge in the knee.  This gel was injected into the site of the origin of the adductor longus in order to increase the healing process and produce scar tissue more closely related to normal anatomy.

The athlete was cleared for participation and played in the final two playoff games with out any further complaints.  The athlete has since participated in one off-season conditioning program and one full NFL season with out any further adductor related issues.

 

References

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4. Moore, K.L. (1992) Clinically Oriented Anatomy 3rd Edition. Williams and Wilkins.

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