Progression of Strength, Flexibility, and Palpation Pain During Rehabilitation of Athletes With Acute Adductor Injuries: A Prospective Cohort Study.

OBJECTIVE: To investigate the relationship between repeated clinical measures and the progression of rehabilitation of male athletes with acute adductor injuries. DESIGN: Prospective observational cohort study. METHODS: Male athletes with acute adductor injuries received a standardized criteria-based rehabilitation program with 4 repeated clinical measures during rehabilitation: the extent of palpation pain (length and width in centimeters), the bent-knee fall-out test (BKFO; in centimeters), hip abduction range of motion (in degrees), and eccentric hip adduction strength (in Newton meters per kilogram). We analyzed the association between each clinical measure and the percent progression of rehabilitation until return to sport (RTS), divided into 2 RTS milestones: (1) clinically pain free, and (2) completion of controlled sports training. RESULTS: The analyses included 61 male athletes for RTS milestone 1 and 50 athletes for RTS milestone 2, and 381 to 675 tests were performed for each clinical measure. The median time to RTS milestones 1 and 2 was 15 days (interquartile range, 12-29 days) and 24 days (interquartile range, 16-34 days), respectively. Each repeated clinical measure individually explained 13% to 36% of the variance in rehabilitation progression to the RTS milestones. The extent of palpation pain explained the highest variance of the progression of rehabilitation (R2 = 0.26-0.27 for length and R2 = 0.36 for width, P<.001). Eccentric adduction strength (R2 = 0.19-0.27, P<.001) improved throughout rehabilitation, whereas the flexibility tests (BKFO, R2 = 0.13-0.15; P<.001 and hip abduction range of motion, R2 = 0.19-0.21; P<.001) returned to normal values early in rehabilitation. CONCLUSION: Repeated measures of adductor strength, flexibility, and palpation pain provided only a rough impression of rehabilitation progress following acute adductor injuries in male athletes. These clinical measures cannot define a precise recovery point during rehabilitation. J Orthop Sports Phys Ther 2021;51(3):126-134. Epub 28 Oct 2020. doi:10.2519/jospt.2021.9951.

Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study.

BACKGROUND: Despite being one of the most common sports injuries, there are no criteria-based rehabilitation programs published for acute adductor injuries. PURPOSE: To evaluate return-to-sport (RTS) outcomes and reinjuries after criteria-based rehabilitation for athletes with acute adductor injuries. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Male adult athletes with an acute adductor injury underwent a supervised, standardized criteria-based exercise rehabilitation program. Magnetic resonance imaging (MRI) was used to grade the injury extent from 0 (negative finding) to 3 (complete tear/avulsion). There were 3 milestones used to evaluate the RTS continuum: (1) clinically pain-free, (2) completion of controlled sports training, and (3) return to full team training. Subsequent injuries were registered within the first year. RESULTS: We included 81 athletes with an acute adductor injury (MRI grade 0: n = 14; grade 1: n = 20; grade 2: n = 30; grade 3: n = 17). Of these, 61 (75%) athletes achieved RTS milestone 1, 50 (62%) achieved RTS milestone 2, and 75 (93%) achieved RTS milestone 3. There were no statistical differences in the RTS duration between MRI grade 0, 1, and 2 at any RTS milestone; thus, these were grouped together as grade 0-2. The median time (interquartile range [IQR]) for athletes with grade 0-2 injuries to become clinically pain-free was 13 days (IQR, 11-21 days), to complete controlled sports training was 17 days (IQR, 15-27 days), and to return to full team training was 18 days (IQR, 14-27 days). For athletes with a grade 3 injury, median times were 55 days (IQR, 31-75 days), 68 days (IQR, 51-84 days), and 78 days (IQR, 68-98 days), respectively. The overall 1-year reinjury rate was 8%. Athletes who achieved RTS milestone 1 had a statistically significantly lower reinjury rate than athletes who did not (5% vs 21%, respectively; ϕ = -0.233; P = .048). Athletes who achieved RTS milestone 2 had a nonstatistically significantly lower reinjury rate than athletes who did not (6% vs 13%, respectively; ϕ = -0.107; P = .366). CONCLUSION: We analyzed the results of a criteria-based rehabilitation protocol for athletes with acute adductor injuries. Athletes with an MRI grade 0-2 adductor injury were clinically pain-free after approximately 2 weeks and returned to full team training after approximately 3 weeks. Most athletes with an MRI grade 3 adductor injury were pain-free and returned to full team training within 3 months. Meeting the clinically pain-free criteria resulted in fewer reinjuries compared with not meeting the criteria.