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General Orthopaedics

Successful return to high level sports following early surgical repair of complete sleeve avulsions of the adductor complex in combination with the rectus abdominis and pectineus: a rare injury

British Orthopaedic Association 2012 Annual Congress



Abstract

Background

Adductor muscle and tendon injuries are commonly seen in sport. Complete adductor avulsions have been described and can be managed non-operatively or operatively. A rare variant of this injury is the complete avulsion of the adductor complex with the pectineus and rectus abdominus amounting to a complete sleeve avulsion from the pubis. This is a severe injury that is increasingly recognised due to improved imaging and lower diagnostic threshold.

Purpose

We describe the surgical management of twelve athletes with this severe injury.

Study design

Prospective case series - Level of evidence, 4.

Methods

All the injuries were prospectively collected onto our institutional pelvic sports injury database. This series summarises the outcome in twelve consecutive cases where surgery was undertaken after presentation with an acute avulsion (6–34 days) in athletes. The procedure comprised anatomical reattachment of the avulsed tissues with mesh reinforcement of the inguinal wall in seven patients. An independent physiotherapist reviewed all patients.

Results

One patient developed a superficial wound infection treated with antibiotics. Transient complaints of local numbness were common but all twelve sportsmen returned to high-level sport (five elite) at an average of thirteen weeks (10–21 weeks).

Conclusion

Awareness of the possibility of this complex injury is important and there should be a low threshold for investigation. In elite athletes operative intervention is associated with good clinical outcomes and successful return to sport.