内收肌长肌腱的完全撕脱是严重的损伤,然而,我们几乎没有数据可以为临床管理决策提供依据.先前的研究由于缺乏详细的随访而受到限制。
描述接受基于运动的治疗的运动员完全近端内收肌长撕脱伤1年后的详细临床和影像学测量。
案例系列;证据水平,4.
在急性内收肌长肌腱撕脱伤7天后,共有16名成年男性竞技运动员被纳入本研究。建议所有运动员完成有监督的基于标准的标准化康复方案。标准化临床检查,修改后的哥本哈根髋部和腹股沟结果评分(HAGOS),奥斯陆运动创伤研究中心过度使用伤害问卷(OSTRC-O),纳入后进行详细的磁共振成像(MRI)评估,在完成治疗方案(恢复运动)的当天,以及受伤后1年的随访。
一名球员失去了后续行动。平均重返运动时间为69天(四分位数间距[IQR],62-84).一名球员早期受伤,并进行了额外的康复期。一年的随访完成了405天的中位数(IQR,372-540)受伤后。所有分量表(IQRs从85-100到100-100)的中位HAGOS评分为100,OSTRC-O评分中位数为0(IQR,0-0)。运动对称性的中值范围为100%(IQR,97%-130%)用于弯曲膝盖脱落测试和102%(IQR,99%-105%)用于侧卧外展试验。侧卧偏心内收强度对称性为92%±13%(平均值±SD),中位仰卧偏心内收强度对称性为93%(IQR,89%-105%)。随访1年的MRI结果显示,从所有病例的原始完全不连续性来看,10名运动员(71%)有部分肌腱连续性,和4(29%)有完整的肌腱连续性。
经非手术治疗的完全急性内收肌长撕脱伤的运动员在2至3个月内恢复运动。在受伤后1年的随访中,运动员有很高的自我报告功能,没有性能限制,正常内收肌强度和运动范围,和MRI显示的部分或全部肌腱连续性的迹象。这表明,由于恢复运动的时间很短,因此对患有急性内收肌腱撕脱的运动员的主要治疗方法应该是非手术的。有良好的长期结果,并且没有手术并发症的风险。
Complete avulsions of the adductor longus tendon are serious injuries, yet we have few data to inform clinical decisions on management. Previous studies are limited by a lack of detailed follow-up.
To describe detailed clinical and imaging measures 1 year after complete proximal adductor longus avulsion injuries in athletes who received exercise-based treatment.
Case series; Level of evidence, 4.
A total of 16 adult male competitive athletes were included in this study <7 days after an acute adductor longus tendon avulsion injury. All athletes were advised to complete a supervised standardized criterion-based rehabilitation protocol. Standardized clinical examination, a modified Copenhagen Hip and Groin Outcome Score (HAGOS), the Oslo Sports Trauma Research Centre Overuse Injury Questionnaire (OSTRC-O), and detailed magnetic resonance imaging (MRI) assessment were performed after inclusion, on the day of completion of the treatment protocol (return to sport), and at 1-year follow-up after injury.
One player was lost to follow-up. Median return-to-sport time was 69 days (interquartile range [IQR], 62-84). One player had an early reinjury and performed an additional rehabilitation period. One-year follow-up was completed a median from 405 days (IQR, 372-540) after injury. The median HAGOS score was 100 for all subscales (IQRs from 85-100 to 100-100), and the median OSTRC-O score was 0 (IQR, 0-0). The median range of motion symmetry was 100% (IQR, 97%-130%) for the bent-knee fall-out test and 102% (IQR, 99%-105%) for the side-lying abduction test. Side-lying eccentric adduction strength symmetry was 92% ± 13% (mean ± SD), and median supine eccentric adduction strength symmetry was 93% (IQR, 89%-105%). MRI results at 1-year follow-up showed that from the original complete discontinuity in all cases, 10 athletes (71%) had partial tendon continuity, and 4 (29%) had complete tendon continuity.
Nonsurgically treated athletes with a complete acute adductor longus avulsion returned to sport in 2 to 3 months. At the 1-year follow-up after injury, athletes had high self-reported function, no performance limitations, normal adductor strength and range of motion, and signs of partial or full tendon continuity as shown on MRI. This indicates that the primary treatment for athletes with acute adductor longus tendon avulsions should be nonsurgical as the time to return to sport is short, there are good long-term results, and there is no risk of surgical complications.