Summary

Surgical reconstruction of acute traumatic avulsions of the adductor longus fibrocartilaginous entheses involving the PLAC was associated with early return to preoperative level of sporting function with no risk of injury recurrence, high levels of patient satisfaction, improvements in functional outcomes and low risk of postoperative complications at short-term follow-up.

Abstract

Background

The outcomes of surgical reconstruction for traumatic avulsions of the proximal adductor longus fibrocartilage entheses involving the pyramidalis, anterior pubic ligament, and adductor longus complex (PLAC) remain unknown. The study explores the efficacy of surgical reconstruction for these injuries on return to preinjury level of sporting activity, injury recurrence, patient satisfaction, functional performance and complications.

Methods

This prospective, single-surgeon study included 62 professional athletes (52 males and 10 females) with a mean age of 27.2 years (range, 18 - 36 years) with acute traumatic avulsions of the proximal adductor longus tendon involving the PLAC (type I = 28 patients (45.2%), type II = 24 patients (38.7%), type III = 2 patients (3.3%), type IV = 2 patients (3.3%), type V = 6 patients (9.7%), and type VI = 0 patients(0%). All study subjects underwent surgical reconstruction with suture anchor fixation. A standard rehabilitation protocol was followed postoperatively. Mean follow-up time was 4.2 years (range, 2.1 to 8.1 years) from date of surgery.

Results

All patients returned to their pre-injury activity level. Mean time from surgical intervention to return to full sporting activity was 12.3 ± 2.2 weeks (range, 9-18 weeks) with no injury recurrence at two-years following surgery. Overall, 46 patients (74.2%) were highly satisfied and 16 patients (25.8%) were satisfied with the outcomes of their surgery, and improvements were observed in the mean lower extremity functional scores (80.2 ? 4.2 versus 49.7 ? 5.2 respectively, p<0.001) and Marx Activity Rating Scale scores (12.8 ? 1.8 versus 3.1 ? 1.2 respectively, p<0.001) compared with preoperative values. Five patients had postoperative wound complications and one patient had postoperative neuroma-related pain.

Conclusion

Surgical reconstruction of acute traumatic avulsions of the adductor longus fibrocartilaginous entheses involving the PLAC was associated with early return to preoperative level of sporting function with no risk of injury recurrence, high levels of patient satisfaction, improvements in functional outcomes and low risk of postoperative complications at short-term follow-up.