Adductor tendon surgery involves release, debridement, or repair of the adductor longus tendon at its attachment to the pubic bone. It is performed for chronic athletic groin pain (sports hernia / athletic pubalgia) that has not responded to rehabilitation.
An incision is made in the groin crease. The adductor longus tendon origin is identified. For chronic tendinopathy: the degenerate tendon is debrided and the origin partially released (adductor tenotomy). For acute avulsion: the tendon is reattached to bone with suture anchors. The procedure may be combined with inguinal repair (Gilmore's groin) if there is an associated posterior inguinal wall deficiency. The operation takes 45–90 minutes.
Surgery is considered for chronic athletic groin pain with confirmed adductor tendinopathy on MRI that has not responded to at least three to six months of dedicated rehabilitation (isometric and heavy slow resistance exercises, graduated return to sport programme).
Structured rehabilitation programme (the Hölmich protocol), activity modification, corticosteroid or PRP injection, and shockwave therapy. Approximately 70–80% of athletes improve with non-operative management.
MRI to confirm adductor tendinopathy. Clinical assessment to exclude other causes of groin pain (hip joint pathology, inguinal hernia, nerve entrapment). Diagnostic injection may help confirm the source.
Return to sport in approximately 80–85% of athletes. Recovery takes three to four months.
Soreness in the groin for several weeks.
Some loss of adduction strength, particularly after tenotomy.
Not all athletes achieve full pain resolution.
Permanent reduction in adduction power after tenotomy. Usually functionally acceptable.
Obturator nerve or ilioinguinal nerve.
Wound infection.
Symptoms may recur with return to sport.
General or spinal anaesthesia.
Light walking immediately. Graduated rehabilitation programme over three to four months. Running at six to eight weeks. Sport-specific training at ten to twelve weeks. Full return to sport at three to four months.
Review at two weeks and six weeks. Graduated return to sport supervised by physiotherapy.
Athletic pubalgia is a broad term for exercise-related groin pain involving the adductor tendons, pubic symphysis, and/or posterior inguinal wall. It is not a true hernia in most cases. Multiple structures may be involved simultaneously.
The groin is an anatomical crossroads where multiple structures (adductors, rectus abdominis, inguinal canal, hip joint, obturator nerve) converge. Identifying the primary pain generator requires careful clinical assessment, imaging, and sometimes diagnostic injections.