Adductor longus proximal tears. A report of non-surgical treatment in 3 professional athletes

BACKGROUND: Although proximal adductor longus injuries have been recognized as the most common injuries of the medial compartment of the thigh, proximal injuries represent a small proportion. They frequently occur in athletes and can lead to significant loss of time from training or competition. Both conservative and operative treatments have been described in the literature. However, the management of these injuries remains controversial.  Surgical treatment was previously preferred due to the common thought that only by restoring the anatomical length, the muscle would function properly, especially when significant retraction was present. The current study aimed to present a conservative treatment approach for proximal adductor longus injuries in elite athletes with a complete functional recovery. CASE SERIES: In this article, we present three cases of professional athletes who experienced a Munich Type 4 adductor longus proximal injury. After physical examination, MRI examinations showed a retraction of 4.85 cm (first case), 2.3 cm (second case), and 1 cm (third patient). Patients underwent conservative treatment and followed a strict return to play protocol that allowed them to return to competition between 2 and 4 months after injury, respectively, without any deficit. CONCLUSIONS: Severe proximal adductor longus injuries in athletes can be treated nonoperatively while still achieving complete recovery in terms of strength and performance and avoiding the complications associated with surgery.