Understanding the Problem: Groin Pain in Athletes

Groin pain is one of the most stubborn injuries for athletes, particularly those involved in sports like soccer, hockey, and rugby. A common source is the adductor longus tendon, which connects the inner thigh muscle to the pelvis. When this tendon becomes chronically inflamed or degenerates (a condition called adductor tendinopathy), patients often experience sharp pain with sprinting, cutting, or kicking.

Physical therapy and strengthening programs can help many athletes recover, but about 20% of patients fail conservative care and require surgical options.

Traditional Approach: Full Release Surgery

Historically, surgeons treated stubborn groin pain by performing a full adductor longus release, cutting the tendon completely from its pelvic attachment. While this relieved pain, the trade-offs included:

• Loss of strength in the inner thigh.

• Pelvic instability, which can affect running and cutting.

• Delayed recovery, with average return to sport taking up to 18 weeks.

• Lower success rates, with only about 54–68% of athletes returning to their previous level of play.

A Modern Alternative: Selective Tenotomy

Instead of cutting the entire tendon, selective partial tenotomy is a technique that only targets the diseased or overloaded fibers are released, while the majority of the tendon remains intact.

Why this matters:

• It reduces strain at the painful site.

• It preserves most of the muscle’s strength.

• It maintains pelvic stability, which is critical for athletes.

• It allows for a quicker and more confident return to activity.

What the Research Shows

A landmark study by Schilders et al. (2013) evaluated 43 professional soccer and rugby players who underwent selective partial adductor release.

The results were impressive:

• 42 out of 43 athletes (98%) returned to their preinjury level of sport.

• Average return to play was just over 9 weeks (compared to 18+ weeks with full release).

• Pain scores dropped from 5.8 to 0.2 out of 10 after surgery.

• No complications were reported, and long-term outcomes were excellent.

By contrast, older studies on full adductor release showed lower return-to-play rates and measurable long-term weakness (Maffulli et al, 2012; Akermark & Johansson, 1992; Robertson et al, 2010; Atkinson et al, 2010).

Recovery and Rehabilitation

After selective release, rehab starts almost immediately:

• Stretching and gentle exercises begin within days.

• Jogging is typically possible within 7–10 days.

• Sport-specific drills and cutting movements are added after 3–4 weeks.

• Full return to competition averages 9–12 weeks.

This structured but accelerated recovery makes the procedure especially attractive for professional and recreational athletes eager to get back on the field.

Who Should Consider Selective Release?

Selective tenotomy may be recommended for:

• Athletes with chronic groin pain lasting more than 3 months.

• Patients with adductor longus tendinopathy confirmed on imaging.

• Individuals who have not improved with strengthening, rest, or injections.

It may not be the best choice for patients with multiple injuries, acute tendon avulsions, or significant hip joint pathology. A thorough evaluation by a sports medicine specialist is essential.

Key Takeaways for Patients

• Full adductor release can relieve pain but often causes weakness and delayed recovery.

• Selective adductor longus release preserves function and offers faster, more reliable outcomes.

• In professional athletes, success rates approach 98% return to preinjury sport within 9 weeks.

• The procedure is minimally invasive and followed by an accelerated rehab plan.

Final Thoughts

Groin pain can be career-limiting for athletes and life-altering for active adults. With the evolution of surgical techniques, selective adductor longus tenotomy provides a safer, more effective solution than traditional full release.

If you’re struggling with chronic groin pain that hasn’t improved with therapy, it’s worth discussing this option with a sports medicine surgeon. At Boston Sports & Biologics, we specialize in advanced, minimally invasive procedures like selective tenotomy to help athletes return to their sport stronger and sooner.

References

Åkermark C and Johansson C. Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. The American Journal of Sports Medicine 1992; 20: 640 - 643-640 - 643. DOI:10.1177/036354659202000604.

Atkinson H, Parminder J, Falworth M, et al. Adductor tenotomy: its role in the management of sports-related chronic groin pain. Archives of Orthopaedic and Trauma Surgery 2010; 130: 965-970-965-970. DOI: 10.1007/s00402-009-1032-4.

Maffulli N, Loppini M, Longo U, et al. Bilateral Mini-Invasive Adductor Tenotomy for the Management of Chronic Unilateral Adductor Longus Tendinopathy in Athletes. The American Journal of Sports Medicine 2012; 40: 1880 - 1886-1880 - 1886. DOI: 10.1177/0363546512448364.

Robertson IJ, Curran C, McCaffrey N, et al. Adductor Tenotomy in the Management of Groin Pain in Athletes. International Journal of sports Medicine 2010; 32: 45 - 48-45 - 48. DOI: 10.1055/s-0030-1263137.

Schilders E, Dimitrakopoulou A, Cooke M, et al. Effectiveness of a Selective Partial Adductor Release for Chronic Adductor-Related Groin Pain in Professional Athletes. The American Journal of Sports Medicine 2013; 41: 603 - 607-603 - 607. DOI: 10.1177/0363546513475790.