https://pubmed.ncbi.nlm.nih.go...Chronic groin pain can be one of the most frustrating injuries for athletes and active individuals. It often lingers despite rest, physical therapy, and injections—and when it doesn’t improve, treatment options historically jump straight from conservative care to open surgery.

For patients with chronic adductor longus tendinopathy, a newer option is emerging: ultrasound-guided tenotomy using the Tenex system. Recent clinical evidence suggests this minimally invasive approach may effectively relieve pain, restore function, and allow a faster return to sport—without the morbidity of traditional surgery.

Understanding Adductor Longus Tendinopathy

The adductor longus is one of the most commonly injured tendons in the groin. While acute adductor strains often resolve with rehabilitation, chronic adductor-related groin pain behaves differently.

Research shows that chronic adductor longus tendinopathy is degenerative rather than inflammatory. Instead of active inflammation, the tendon demonstrates:

• Collagen disorganization

• Mucoid degeneration

• Poor vascularity

• Microtearing at the pubic attachment

These changes limit the tendon’s ability to heal on its own, which explains why rest, anti-inflammatory treatments, and repeated physical therapy may fail [Khan et al, 1999].

Why Traditional Surgery Isn’t Always Ideal

When conservative care fails, surgical options such as open or partial adductor tenotomy have traditionally been considered. There is no consensus in the literature regarding the optimal surgical approach.

Both “partial” and “total tenotomy” techniques offer similar efficacy for pain relief. However, studies have demonstrated that a complete tenotomy of the adductor longus tendon may relieve symptoms, but at the expense of strength, with variable outcomes upon return to sport.

• In a series involving 18 complete tenotomies performed in 16 male athletes, postoperative strength on the operative side was reduced by approximately 20% compared with the contralateral limb, and fewer than two-thirds of athletes were able to return to their preinjury level of sport [Åkermark et al, 1992].
• Additional studies have reported return-to-sport rates ranging from 54% to 85% after complete tenotomy, reflecting heterogeneity in patient populations and surgical techniques [Maffulli et al, 2012; Robertson et al, 2010; Atkinson et al, 2010].

What Is Tenex (Ultrasound-Guided Tenotomy)?

Tenex is a minimally invasive procedure that uses a specialized microtip to:

• Precisely cut and remove degenerative tendon tissue

• Preserve healthy tendon fibers

• Stimulate the body’s natural healing response

The procedure is performed under real-time ultrasound guidance, allowing the physician to directly visualize the tendon, avoid nearby nerves and vessels, and target only the diseased tissue.

Importantly, Tenex acts as a tissue-preserving debridement, making it particularly attractive for athletes concerned about strength and performance.

Techniques that allow direct visualization of the tendon, such as endoscopic or ultrasound-guided approaches, may reduce these risks. Ultrasound, in particular, is already well established as a tool for diagnosing adductor longus tendinopathy. However, ultrasound-guided release of the adductor longus tendon is not always offered.

Advantages of Tenex for Chronic Groin Pain

Compared with traditional surgical approaches, Tenex offers several potential benefits:

• Minimally invasive ultrasound-guided technique

• Local anesthesia only (no general anesthesia)

• Preservation of tendon integrity

• Real-time ultrasound precision

For appropriately selected patients, Tenex may function as an intermediate treatment option—more targeted than injections, but far less disruptive than open surgery.

Conclusion

Chronic adductor longus tendinopathy is a challenging condition that often resists traditional treatment. Ultrasound-guided Tenex tenotomy offers a promising, evidence-supported alternative that targets the underlying degenerative tendon pathology while minimizing risk and downtime.

As clinical experience and research continue to expand, Tenex may become a key part of the treatment algorithm for athletes and active individuals seeking durable relief from chronic groin pain—without sacrificing performance

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.

Capurro B, Chapman RS, Kaplan DJ, et al. The Genitofemoral Nerve Is the Structure Closest to the Tendon Footprint and Is Most at Risk for Iatrogenic Injury During Proximal Adductor Longus Repair: A Cadaveric Anatomy Study. Arthroscopy, Sports Medicine, and Rehabilitation 2024; 6: 100970. DOI: https://doi.org/10.1016/j.asmr.2024.100970.

Khan KM, Cook JL, Bonar F, et al. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med 1999; 27: 393-408. DOI: 10.2165/00007256-199927060-00004.

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.

O'Donnell R, DeFroda S, Bokshan SL, et al. Cadaveric Analysis of Key Anatomic Structures of Athletic Pubalgia. J Am Acad Orthop Surg Glob Res Rev 2023; 7 20230614. DOI: 10.5435/JAAOSGlobal-D-23-00070.

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.

Santamaría-Le Pera J, Valera-Garrido F, Valderrama-Canales FJ, et al. Are palpation-guided interventional procedures on the adductor longus muscle safe? A cadaveric and sonographic investigation. Surg Radiol Anat 2025; 47: 74. 20250207. DOI: 10.1007/s00276-025-03567-2.