Return to Preoperative Level of Sporting Function after Surgical Repair of the Pyramidalis–Anterior Pubic Ligament–Adductor Longus Complex in Professional Athletes

Abstract

Background:

The outcomes of surgical repair for traumatic avulsions of the pyramidalis, anterior pubic ligament, adductor longus complex (PLAC) remain unknown.

Purpose:

To report how surgical repair for PLAC injuries in professional athletes affected return to preinjury level of sporting activity, injury recurrence, patient satisfaction, functional performance, and complications.

Study Design:

Case series; Level of evidence, 4.

Methods:

This retrospective, single-surgeon study included 62 professional athletes. Inclusion criteria for study participation were professional athletes, primary injury within 28 days of surgical intervention, magnetic resonance imaging scan confirming complete avulsion of the proximal adductor longus tendon fibrocartilaginous entheses, patient symptomatic with groin pain and adductor weakness, and surgical intervention undertaken by the senior author. Exclusion criteria were chronic and recurrent adductor injuries; concomitant chronic conditions including osteoarthritis, inguinal hernia, and chronic groin pain; and patient living abroad or not available for follow-up. All study participants underwent surgical repair with suture anchor fixation. A standard rehabilitation protocol was followed postoperatively. The Lower Extremity Functional Scale (LEFS), Marx Activity Rating Scale (MARS), patient satisfaction levels, and time to return to previous level of sport were the primary outcome measures used in this study.

Results:

The mean follow-up time was 4.2 years (range, 2.1-8.1 years) from the date of surgery. The study included 62 professional athletes (52 male, 10 female) 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 62 patients (100%) returned to their preinjury level of sporting activity. The specific level of each sport at which the individuals were performing was not recorded; however, all participants were professional athletes who returned to professional play. The 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 2 years after surgery. Overall, 46 patients (74.2%) were highly satisfied and 16 patients (25.8%) were satisfied with the outcomes of their surgery. Improvements were observed in the mean LEFS (from 49.7 ± 5.2 points preoperatively to 80.2 ± 4.2 points at 2-year follow-up; P < .001). In addition, 48 patients (77.4%) had a LEFS of 75 points, and 12 patients (19.4%) achieved the maximum LEFS score of 80 points at 2-year follow-up. Improvements were also seen in MARS scores (from 3.1 ± 1.2 points preoperatively to 12.8 ± 1.8 points at 2-year follow-up; P < .001). In total, 46 patients (74.2%) achieved a MARS score of 12 points, and 14 patients (22.6%) achieved the maximum MARS score of 16 points at 2-year follow-up. Four patients had postoperative wound complications, and 1 patient had postoperative neuroma-related pain.

Conclusion:

Surgical repair of acute traumatic avulsions of the adductor longus fibrocartilaginous entheses involving the PLAC was associated with early return to preoperative level of sporting function in professional athletes, 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.