Associations between clinical findings and MRI injury extent in male athletes with acute adductor injuries - A cross-sectional study

Factors associated with injury and re-injury occurrence in female pole dancers

The aim of the study was to recognise what participant-, training- and post-injury-related factors are associated with an injury and re-injury occurrence in female pole dancers (PDs). 320 female PDs fulfilled a custom survey. 1050 injuries were reported by 276 PDs, 59% of injuries were related to lower extremity, 39% to upper extremity and 10% to spine and trunk. 156 PDs reported sustaining a re-injury, and overall, 628 re-injuries were reported. The median weekly pole-specific training session volume was 90 min and 240 min in the low and high qualified group, respectively. The total training volume was 180 min in the low qualified PDs and 240 min in the high qualified group. PDs with higher height and spending more time on pole-specific training in studio and on other forms of training have higher odds of sustaining an injury. PDs with lower level of experience in training, who sustained an injury, and who had a shorter pause between the moment of injury and the return to performance, and thus who did not fully recover, have higher odds of sustaining a re-injury. Sport-specific injury prevention strategies should be developed and implemented in this cohort, since over 85% of pole dancers reported sustaining some kind of injury.

One-Year Clinical and Imaging Follow-up After Exercise-Based Treatment for Acute Complete Adductor Longus Tendon Avulsions in Athletes: A Prospective Case Series

BACKGROUND

Complete avulsions of the adductor longus tendon are serious injuries, yet we have few data to inform clinical decisions on management. Previous studies are limited by a lack of detailed follow-up.

PURPOSE

To describe detailed clinical and imaging measures 1 year after complete proximal adductor longus avulsion injuries in athletes who received exercise-based treatment.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

A total of 16 adult male competitive athletes were included in this study <7 days after an acute adductor longus tendon avulsion injury. All athletes were advised to complete a supervised standardized criterion-based rehabilitation protocol. Standardized clinical examination, a modified Copenhagen Hip and Groin Outcome Score (HAGOS), the Oslo Sports Trauma Research Centre Overuse Injury Questionnaire (OSTRC-O), and detailed magnetic resonance imaging (MRI) assessment were performed after inclusion, on the day of completion of the treatment protocol (return to sport), and at 1-year follow-up after injury.

RESULTS

One player was lost to follow-up. Median return-to-sport time was 69 days (interquartile range [IQR], 62-84). One player had an early reinjury and performed an additional rehabilitation period. One-year follow-up was completed a median from 405 days (IQR, 372-540) after injury. The median HAGOS score was 100 for all subscales (IQRs from 85-100 to 100-100), and the median OSTRC-O score was 0 (IQR, 0-0). The median range of motion symmetry was 100% (IQR, 97%-130%) for the bent-knee fall-out test and 102% (IQR, 99%-105%) for the side-lying abduction test. Side-lying eccentric adduction strength symmetry was 92% ± 13% (mean ± SD), and median supine eccentric adduction strength symmetry was 93% (IQR, 89%-105%). MRI results at 1-year follow-up showed that from the original complete discontinuity in all cases, 10 athletes (71%) had partial tendon continuity, and 4 (29%) had complete tendon continuity.

CONCLUSION

Nonsurgically treated athletes with a complete acute adductor longus avulsion returned to sport in 2 to 3 months. At the 1-year follow-up after injury, athletes had high self-reported function, no performance limitations, normal adductor strength and range of motion, and signs of partial or full tendon continuity as shown on MRI. This indicates that the primary treatment for athletes with acute adductor longus tendon avulsions should be nonsurgical as the time to return to sport is short, there are good long-term results, and there is no risk of surgical complications.

[Avulsion injuries of the adductors and iliopsoas]

Avulsion injuries of the tendon-bone junction of the adductor longus are rare. Avulsions of the iliopsoas tendon insertion on the lesser trochanter are even rarer. Avulsion injuries of the adductor insertion occur predominantly in active athletes. Iliopsoas tendon avulsions are described mainly in nonathletes, in old age and frequently with no triggering event. In these cases possible underlying pathologies (e.g. tumor or metastases in the lesser trochanter) must be ruled out. In the literature no generally accepted recommendations for treatment of these injuries can be found because only a few retrospective anecdotal case reports and case studies have been published. For this reason, it is mostly unclear if and when a conservative or operative approach is indicated.A PubMed/Medline literature search resulted in 86 articles for iliopsoas avulsions and 155 hits for adductor tendon avulsions. Accordingly, both injuries can basically be treated conservatively. A surgical treatment is recommended only occasionally when conservative treatment fails and when the adductor insertion or the apophysis of the lesser trochanter is dislocated more than 2 cm after avulsion. Reinsertion for adductor longus tendon avulsion injuries is usually performed by open repair using various anchor systems, while extensive avulsion injuries or non-unions of the apophysis of the lesser trochanter are treated by refixation by cannulated screw systems or resection and anchor refixation of the tendon. The postoperative outcome in most cases is described as good or very good (excellent). No major complications were reported in both groups.