TY - JOUR

T1 - Associations Between Initial Clinical Examination and Imaging Findings and Return-to-Sport in Male Athletes With Acute Adductor Injuries

T2 - A Prospective Cohort Study

AU - Serner, Andreas

AU - Weir, Adam

AU - Tol, Johannes L

AU - Thorborg, Kristian

AU - Yamashiro, Eduardo

AU - Guermazi, Ali

AU - Roemer, Frank W

AU - Hölmich, Per

PY - 2020

Y1 - 2020

N2 - BACKGROUND: Time to return-to-sport (RTS) after acute adductor injuries varies among athletes, yet we know little about which factors determine this variance.PURPOSE: To investigate the association between initial clinical and imaging examination findings and time to RTS in male athletes with acute adductor injuries.STUDY DESIGN: Cohort study (Prognosis); Level of evidence, 2.METHODS: Male adult athletes with an acute adductor injury were included within 7 days of injury. Standardized patient history and clinical and magnetic resonance imaging (MRI) examinations were conducted for all athletes. Athletes performed a supervised standardized criteria-based exercise treatment program. Three RTS milestones were defined: (1) clinically pain-free, (2) completed controlled sports training, and (3) first full team training. Univariate and multiple regression analyses were performed to determine the association between the specific candidate variables of the initial examinations and the RTS milestones.RESULTS: We included 81 male adult athletes. The median duration for the 3 RTS milestones were 15 days (interquartile range, 12-28 days), 24 days (16-32 days), and 22 days (15-31 days), respectively. Clinical examination including patient history was able to explain 63%, 74%, and 68% of the variance in time to RTS. The strongest predictors for longer time to RTS were pain on palpation of the proximal adductor longus insertion or a palpable defect. The addition of MRI increased the explained variance with 7%, 0%, and 7%. The strongest MRI predictor was injury at the bone-tendon junction. Post hoc multiple regression analyses of players without the 2 most important clinical findings were able to explain 24% to 31% of the variance, with no added value of the MRI findings.CONCLUSION: The strongest predictors of a longer time to RTS after acute adductor injury were palpation pain at the proximal adductor longus insertion, a palpable defect, and/or an injury at the bone-tendon junction on MRI. For athletes without any of these findings, even extensive clinical and MRI examination does not assist considerably in providing a more precise estimate of time to RTS.

AB - BACKGROUND: Time to return-to-sport (RTS) after acute adductor injuries varies among athletes, yet we know little about which factors determine this variance.PURPOSE: To investigate the association between initial clinical and imaging examination findings and time to RTS in male athletes with acute adductor injuries.STUDY DESIGN: Cohort study (Prognosis); Level of evidence, 2.METHODS: Male adult athletes with an acute adductor injury were included within 7 days of injury. Standardized patient history and clinical and magnetic resonance imaging (MRI) examinations were conducted for all athletes. Athletes performed a supervised standardized criteria-based exercise treatment program. Three RTS milestones were defined: (1) clinically pain-free, (2) completed controlled sports training, and (3) first full team training. Univariate and multiple regression analyses were performed to determine the association between the specific candidate variables of the initial examinations and the RTS milestones.RESULTS: We included 81 male adult athletes. The median duration for the 3 RTS milestones were 15 days (interquartile range, 12-28 days), 24 days (16-32 days), and 22 days (15-31 days), respectively. Clinical examination including patient history was able to explain 63%, 74%, and 68% of the variance in time to RTS. The strongest predictors for longer time to RTS were pain on palpation of the proximal adductor longus insertion or a palpable defect. The addition of MRI increased the explained variance with 7%, 0%, and 7%. The strongest MRI predictor was injury at the bone-tendon junction. Post hoc multiple regression analyses of players without the 2 most important clinical findings were able to explain 24% to 31% of the variance, with no added value of the MRI findings.CONCLUSION: The strongest predictors of a longer time to RTS after acute adductor injury were palpation pain at the proximal adductor longus insertion, a palpable defect, and/or an injury at the bone-tendon junction on MRI. For athletes without any of these findings, even extensive clinical and MRI examination does not assist considerably in providing a more precise estimate of time to RTS.

KW - Adult

KW - Athletes

KW - Athletic Injuries/diagnostic imaging

KW - Humans

KW - Magnetic Resonance Imaging

KW - Male

KW - Muscle, Skeletal/injuries

KW - Myalgia

KW - Prospective Studies

KW - Return to Sport

KW - Thigh/injuries

U2 - 10.1177/0363546520908610

DO - 10.1177/0363546520908610

M3 - Journal article

C2 - 32182099

VL - 48

SP - 1151

EP - 1159

JO - American Journal of Sports Medicine

JF - American Journal of Sports Medicine

SN - 0363-5465

IS - 5

ER -