Surgical Management of a Completely Avulsed Adductor Longus Muscle in a Professional Equestrian Rider

Avulsion injuries of the adductor longus muscle tendon are rare and a challenge to manage especially in athletes. There has been little published literature on the outcome of conservative and operative treatment for these injuries. We report the first case of an acute adductor longus avulsion injury which was surgically repaired in a professional equestrian rider. Return to full preinjury function was achieved at 3 months with surgical repair using 3 suture anchors. 1. Introduction Groin injuries are common and account for approximately 5–18% of all athletic injuries with a higher reported incidence in kicking sports [1]. These injuries are often severe and disabling, requiring a lengthy period of recovery. Avulsion injuries of the adductor longus muscle tendon are rare and a challenge to manage especially in athletes. As the exact mechanism of injury is often unclear, the approach to management is difficult and results can be unpredictable. There has been little published literature on the outcome of conservative and operative treatment for these injuries. Most injuries occur proximally at the musculotendinous junction although there have been several reports of injuries occurring at the proximal and distal parts of the adductor longus muscle [1–9]. Tears at the origin are infrequent, with only a few cases reported in the literature [1–5]. Nearly all of these cases were associated with kicking sports and were reattached surgically. We report a case of an acute adductor longus avulsion injury in a professional equestrian rider. To the best of our knowledge, this is the first case report that has demonstrated the successful outcome of bone anchor repair with objective muscle power testing postoperatively. 2. Case Summary A 43-year-old professional equestrian presented to the Accident and Emergency Department complaining of acute groin and lower abdominal pain after horse riding. She describes the pain coming on suddenly whilst jumping a hedge. It was associated with a “snapping sensation” in her left groin as she gripped her horse tightly with her knees while standing in the stirrups. On examination, there was significant swelling with extensive ecchymosis from her inner thigh extending up to her pubic and left inguinal area. She was tender to palpation over the superomedial aspect of her thigh with a palpable gap at the origin of the adductor longus tendon. Adductor muscle power was weak (Medical Research Council grade 2). Magnetic Resonance Imaging (MRI) of the pelvis demonstrated an avulsion of the adductor longus tendon to a distance of 1.2？cm from