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Proximal adductor longus avulsions are challenging injuries to diagnose correctly and manage appropriately. Interestingly most of these cases described a mechanism of injury of wide hip abduction and extension with some internal rotation, a very similar position that our patient was in whilst riding. Found inside Page 32430.1 MRI of an acute tear of the adductor longus at the proximal 30.2 Avulsion of the enthesis (white arrow) of the adductor longus in a professional Hip adductor longus ruptures are most commonly seen in football and ice-hockey [1, 2].Treatment of acute hip adductor longus ruptures in elite athletes includes both surgical and non-surgical approaches [].A case-series from 2009, including 19 American Football players, found that non-surgical treatment of proximal adductor tendon rupture results in faster return-to-play than surgical . is type of injury can take a lengthy time to recover if managed conservatively. Orthop J Sports Med. Digital measurement showed 3.7 mm of retraction of the free margin of the proximal adductor tendon (blue) from the left pubic body origin (red) with interposed focal high intensity fluid signal. 2021 Feb 1;3(1):e227-e232. eCollection 2021 Jun. High-resolution computed tomography may not be required for diagnosis after the MRI, especially if a bone scan has previously been performed. The patient had a history of multiple sclerosis for which intensive physiotherapy sessions have been required. This condition is commonly observed among . Adductor longus Adductor magnus Adductor brevis Gluteus medius Gluteus minimus Tensor fasciae latae Pectineus . The purpose of this study was to report on the clinical out- (A) Coronal T1-weighted and (B) axial proton densityweighted magnetic This book was produced as part of JISC's Institution as e-Textbook Publisher project. Find out more at https://www.jisc.ac.uk/rd/projects/institution-as-e-textbook-publisher 2003; 22: 403407. Arch Orthop Trauma Surg 2007; 127:613. A 43-year-old professional equestrian presented to the Accident and Emergency Department complaining of acute groin and lower abdominal pain after horse riding. We believe that surgical repair using mitek suture anchors is an option worth considering especially in active individuals. Groin injuries are common and account for approximately 518% of all athletic injuries with a higher reported incidence in kicking sports [1]. While stress injuries in general are a common occurrence in athletes, adductor insertion avulsion syndrome (AIAS) is a rare diagnosis along the stress injury spectrum. These injuries are often severe and disabling, requiring a lengthy period of recovery. It is the insertion site of the hamstring muscle group, and avulsions usually occur before closure of the apophysis (, 9,, 10).Avulsion is caused by extreme active contraction of the hamstrings during, for example, sprinting by runners or sudden and excessive . Surgeon. 2010;130(8):965970. Accessibility DOI: https://doi.org/10.1007/s00256-004-0864-9, Van Damme K, De Coster L, Mermuys K, Van Den Eeckhaut A, Walgraeve N, De Geeter F. Bone scan findings in calcific tendinitis at the gluteus maximus insertion: some illustrative cases. As such, the proximal phalanx fragments were . DOI: https://doi.org/10.2214/ajr.177.3.1770673, Mahajan MS. High-resolution computed tomography confirmed the stress fracture (Figure 3). Surgical reattachment utilizing a multiple suture anchor technique is a successful procedure that allows for a safe return to athletic performance and a predictable return to sport. Google Scholar | SAGE Journals | ISI3. Clinical Radiology. These lesions present more insidiously, with pain localised mostly at the groin but without a clear history of trauma. eCollection 2019 Mar. Deepak Patkar. Treatment was conservative following a strict rehabilitation plan. Orthopedics. However, traumatic proximal adductor avulsion injuries are relatively rare groin injuries in the athletic population, with limite. PMC Muscle power was tested and compared to the right side using a Kin-Com Dynamometer with software version 5.30HS3. between the tendon complex and superior ramus (blue arrows). Sona Pungavkar. Examination will reveal swelling and tenderness of the inner thigh and potentially a palpable gap at the origin of the adductor longus tendon [19]. Only two patients over 40 have been reported with thigh splints, and neither of them had mentioned any recent athletic activity [3, 5]. Given the retrospective nature of this studys design, there was also no standardized nonoperative rehabilitation program. She undertook no strenuous activities, including horse riding for 3 months. Surgical Management of a Completely Avulsed Adductor Longus Muscle in a Professional Equestrian Rider, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK, ST6 Trauma and Orthopaedic Surgery, East Midlands North Rotation, UK, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth PO6 3LY, UK, A. Dimitrakopoulou, E. M. J. Schilders, J. C. Talbot, and Q. Bismil, Acute avulsion of the fibrocartilage origin of the adductor longus in professional soccer players: a report of two cases,, H. Lohrer and T. Nauck, Proximal adductor longus tendon tear in high level athletes. Patient-reported outcomes (Hip Outcome Score-Activities of Daily Living [HOS-ADL] and Hip Outcome Score-Sport Specific [SS] subscales, modified Harris Hip Score [mHHS], and visual analog scale [VAS] for pain) were collected preoperatively and at a minimum 2-year follow-up. Sports hernias are hard to diagnose because the symptoms are similar to other types of painful groin injuries. Found inside Page 356Nonoperative treatment and return to play after complete proximal adductor avulsion in high-performance athletes. Knee Surg Sports Traumatol Arthrosc. The proximal myotendinous junction is the most frequent location of injuries. Akermark C, Johansson C. Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. Proximal adductor avulsion injuries: outcomes of surgical reattachment in athletes. Figure 2 - Adductor muscle insertion onto D1 Proximal phalanx that can obstruct proximal portion of UCL ligament . The process on the distal aspect of the fibula is termed the: Adductor tubercle. Skeletal Radiol. 2016; 36: 17211722. Bone scan helps pinpoint this pathology, often located at the edge of the field of view of a hip MRI [3]. DOI: https://doi.org/10.1016/j.radcr.2016.11.009, Thornton MJ, Harries SR, Hughes PM, Whitehouse R, Carradine S. Calcific tendinitis of the gluteus maximum tendon with abnormalities of cortical bone. Proximal rupture of the adductor longus tendon is a rare injury, particularly avulsion injures at the pubic bone. On examination, there was significant swelling with extensive ecchymosis from her inner thigh extending up to her pubic and left inguinal area. 2020;104(1):21. Serner A, Hlmich P, Arnaiz J, Tol JL, Thorborg K, Weir A. It has been described in adults [1 . High T2-STIR signal intensity was found in the femoral bone marrow at the same height, adjacent to the adductors insertion site. Hip Adductor Longus Tendon Origin Anatomy Is Consistent and May Inform Surgical Reattachment. Found inside Page 3367 (a, b) Complete bilateral adductor avulsion. (a) Coronal T2w FS and (b) axial oblique 2015) which At the Proximal Myotendinous Junction The adductor The most common finding on MRI is a high signal intensity on T2 STIR weighted image in the soft tissue along the posteromedial proximal femoral shaft at the adductors insertion site [1, 3, 4, 5, 6, 7, 8, 9, 10]. Presentation of a patient with proximal adductor magnus avulsion mimics that of a patient with a proximal hamstring avulsion. -. Methods: Adductor insertion avulsion syndrome with stress fracture of femoral shaft: MRI findings. DOI: https://doi.org/10.2214/ajr.177.3.1770673, https://doi.org/10.1111/j.1440-1673.2007.01799.x, https://doi.org/10.3928/01477447-20120822-37, https://doi.org/10.2214/ajr.176.5.1761227, https://doi.org/10.15659/yeditepemj.15.10.259, https://doi.org/10.7863/jum.2006.25.7.913, https://doi.org/10.7863/jum.2003.22.4.403, https://doi.org/10.1007/s00256-004-0864-9, https://doi.org/10.1016/j.radcr.2016.11.009, https://doi.org/10.1016/S0009-9260(98)80131-1. comments powered by There has been little published literature on the outcome of conservative and operative treatment for these injuries. Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. The knees are Am J Sports Med. To the best of our knowledge, this is the first case report that has demonstrated the successful outcome of bone anchor repair with objective muscle power testing postoperatively. Found inside Page 154Adductor aponeurosis Ulnar collateral ligament A B C D Fig. Avulsion from the proximal phalanx is five times more common than midsubstance tears or Found inside Page 202This is secondary to the FPL becoming caught in a condyle of the proximal Adductor aponeurosis UCL of thumb MP joint UCL avulsion fracture Stener lesion Sonographic findings of adductor insertion avulsion syndrome with magnetic resonance imaging correlation. Careers. At 3-month followup, the patient was back to normal level of physical activities. 3 The tendinous attachments of the hamstrings include the semimembranosus and the conjoined tendon of the semitendinosus and biceps femoris. Proximal Adductor Avulsion Injuries: Outcomes of Surgical Reattachment in Athletes Patient-reported outcomes offer an objective measure of hip function and pain control. resonance imaging scan demonstrating a healed left-sided adductor Serner A, Weir A, Tol JL, et al. Age of the patient? Found insideA comprehensive state of the art of surgical techniques, tissue-engineered nerve graft scaffolds, and their application in nerve regeneration, the advances in peripheral nerve repair and future perspectives will be discussed, including Following parameters were analysed: basic data, mechanism of injury, classification, tendon retraction, size of defect in MRI and . A whole-body bone scanperformed shortly aftershowed an increased radiotracer uptake at the same site on delayed images and a computed tomography exam re-affirmed the periosteal reaction. At this point the patient was fully weight bearing without any pain. Journal of the Belgian Society of Radiology. I2 2017; 168174. It was successfully managed by minimally invasive extensor hallucis brevis tenodesis. Adductor insertion avulsion syndrome (thigh splints): Diagnosis with MRI follow-up. This case emphasizes the importance of recognizing the imaging features of the adductor insertion avulsion syndrome, not to be confused with gluteus maximus insertions lesion, especially in older patients. The purpose of this study was to investigate the detailed anatomy of the entheses and proximal musculotendinous junctions (MTJs) of adductor longus (AL), adductor brevis (AB) and gracilis. Epub 2020 Aug 6. Purpose: To describe detailed clinical and imaging measures 1 year after complete proximal adductor longus avulsion injuries in athletes who received exercise-based treatment. The patient may report an acute onset of pain or tearing sensation in the proximal posterior thigh. - adductor mechanism: - adductor pollicis has superficial insertion into the the extensor mechanism of the thumb (which cover the dorsal capsule and ulnar collateral ligament), and a deep insertion into the proximal phalanx; Found inside Page 427Less commonly , the proximal hamstring tendons are avulsed off the Of the five adductor muscles , the adductor longus is the most frequently injured . Although mainly encountered in young athletes, our case report highlights that elderly people can also be affected. Found inside Page 147An avulsion fracture at the insertion of UCL onto the proximal phalanx is also to the proximal adductor longus tendon show (arrows) abnormal hypoechoic Total rupture of the proximal tendon of adductor muscle is uncommon and reported treatments are usually surgical [3, 10, 15]. One-Year Clinical and Imaging Follow-up After Exercise-Based Treatment for Acute Complete Adductor Longus Tendon Avulsions in Athletes: A Prospective Case Series. What is the name of the process on the posterior lateral aspect of . CaseReportsinOrthopedics 3 tendonwasreattachedtotheperiosteumofthepubisusing titanium corkscrews and Fiberwire number 2 (Arthrex, Naples, FL, USA) [5]. 2001; 177: 673675. AJR Am J Roentgenol. This article describes our surgical technique for management of a rare acute proximal adductor magnus avulsion. Conal Quah, Andrew Cottam, James Hutchinson, "Surgical Management of a Completely Avulsed Adductor Longus Muscle in a Professional Equestrian Rider", Case Reports in Orthopedics, vol. Typical examples occur at the proximal attachment of the gracilis and adductor muscles at the symphysis pubis and the inferior pubic ramus (gracilis-adductor syndrome or proximal chronic avulsive adductor insertion syndrome).27 2021 Sep;49(11):3004-3013. doi: 10.1177/03635465211015996. Epub 2017 May 10. 2018;6(7):2325967118784898. Arthrosc Tech. DOI: https://doi.org/10.1016/S0009-9260(98)80131-1, Pauchet, A., Falticeanu, A. and Lebecque, O., 2020. Found inside Page 180Coronal inversion recovery MR image shows avulsed adductor tendon A partial list includes distal rectus abdominis and/or proximal adductor tear, The ischial tuberosity is the site of origin of the hamstring muscles and adductor magnus (Figure 2) and represents the most common location for avulsion injuries in the pelvis. Found inside Page 627Complete rupture of the UCL often is associated with retraction of the avulsed UCL proximal to the adductor aponeurosis . DOI: http://doi.org/10.5334/jbsr.2014. 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