Interesting case crossed my path. Professional
football player arrived with pelvis MRI that showed avulsion rupture of
adductor longus muscle on insertion on pubic bone. Injury happened at the very
end of the soccer game as he tried to block the ball with his left leg but hit
the player instead. Player describes sharp tearing pain that he felt when
injury happened.
MRI taken just after the injury showed avulsion
tear of adductor longus.
Adductor avulsion injuries usually heal even
unoperated but healing process is about 4 to 6 months with or without
operation. In either approach my main is scar tissue that later on limits the
player ability to return to full professional level of exercise, i prefer
non-operational approach as healing process can be governed and speeded up buy
adequate therapy.
First cycle of therapies consisted of ultrasound
guided aspiration of all fluids around the injured area, some were quite small
(under 0.2ml), as they interfere with normal healing process. (full of
proinflammatory pro apoptotic cytokines) Ultrasound guided prolotherapy
applied, followed by systematic application of high level vitamins especially
vitamin C important for collagen synthesis. Oxygen inhalation and physical
therapy included in the protocol. Therapy continued for 5 days in a row and
followed by MRI.
Comparison 7 days after the therapy, 2 weeks
after initial MRI
Control MRI shows good healing progression and even
a small trace of initial adductor tendon.
Second cycle of ultrasound guided injection
therapies continued after control MRI with oxygen and physical therapy included
in the protocol. No exercise planned, just rest to help tenocites to reconnect
to the bone, as they are very fragile at this stage.
Comparison 7 days after the second therapy cycle, aprox 4
weeks after initial MRI.
Control MRI shows almost complete healing, some
edema still present, scar tissue visibly smaller and fibrous/tendon like tissue
forming in the direction of pubic bone. Low lever exercise planned from this
point forward, with short follow-up therapy after 2 weeks.
Update: Athlete returned to full activity. Over 2 years have passed and no issues or problems with adductor arouse till this day.