What is the best management approach for a patient with an adductor tear?

Management of Adductor Tears

Initial management of adductor tears should prioritize exercise-based rehabilitation with load management strategies, reserving surgical intervention for complete proximal tears with tendon retraction, particularly when performed within the first month of injury.

Initial Conservative Management

Exercise and Load-Based Rehabilitation

• Exercise and loading strategies form the cornerstone of adductor injury management for most cases, from acute strains to chronic adductor-related groin pain 1
• Rehabilitation should be individualized based on injury severity, with specific exercises targeting the adductor complex through progressive loading 1
• Conservative treatment must be given an adequate trial before considering surgical options, though specific duration thresholds vary by injury severity 2

Pain Management Strategy

• Start with paracetamol (acetaminophen) immediately after diagnosis and continue regularly 3, 4
• Add NSAIDs or COX-2 specific inhibitors concurrently with paracetamol for more effective pain control 3, 4
• A single corticosteroid injection with local anesthetic may provide short-term improvement in pain and function 3, 4

Surgical Indications

Complete Proximal Adductor Longus Tears

• Surgical repair with concomitant distal fascial release should be strongly considered for complete proximal adductor longus avulsions with clear tendon retraction, particularly in high-level athletes 5
• Timing is critical: surgery performed within the first month after injury (mean 2.4 weeks) yields excellent outcomes in 57.5% of cases, compared to delayed surgery at 11.4 weeks which yields only good/moderate results 5
• Surgical repair resulted in good or excellent outcomes in 90% of athletes, with most returning to competitive sports within 14 weeks 5

Chronic Adductor-Related Groin Pain

• Tenotomy of the adductor longus tendon is an option for chronic groin pain (lasting 2.5-48 months) localized at the muscle origin that is refractory to conservative treatment 2
• All patients showed improvement or became symptom-free at 35-month follow-up, with most returning to full athletic activity within 6.6 weeks 2
• Expect decreased muscle strength post-tenotomy, though this typically does not prevent return to sports 2

Critical Decision Points

When to Refer for Surgical Evaluation

• Complete proximal adductor longus tear with visible tendon retraction on imaging 5
• High-level athlete requiring rapid return to sport 5
• Injury within the past 2-4 weeks (optimal surgical window) 5
• Chronic groin pain (>2.5 months) with distinct pain at adductor origin despite exhaustive conservative treatment 2

Factors Predicting Better Surgical Outcomes

• Earlier surgical intervention (within first month) strongly correlates with excellent outcomes 5
• Younger, high-level athletes tend to achieve better functional recovery 5
• Smaller tears generally have better prognosis than massive complete tears 2, 5

Common Pitfalls to Avoid

• Do not delay surgical referral beyond 4 weeks for complete proximal tears with retraction - outcomes deteriorate significantly with delayed intervention 5
• Avoid multiple corticosteroid injections - these may compromise tissue integrity and future surgical outcomes 3, 6
• Do not rely solely on unsupervised home exercises - structured, load-based rehabilitation programs are essential 1
• Do not assume all adductor pain requires surgery - most cases respond to conservative exercise-based management 1

Prognostic Considerations

• Athletes with complete proximal tears treated surgically within 1 month can expect 90% good-to-excellent outcomes 5
• Return to competitive sports typically occurs within 14 weeks post-surgery for proximal repairs 5
• Chronic cases treated with tenotomy show sustained improvement at nearly 3 years follow-up 2
• Conservative management success depends on adherence to structured exercise protocols and appropriate load progression 1