Postsurgical Rehabilitation: Tendon Surgery

Abstract

Diagnosis and appropriate management in groin pain are difficult and often attributed to the complex anatomy of the groin area with frequent overlapping extra-articular and intra-articular causes. It is important to know that the 27% of the cases of athletic groin pain can be multifactorial. One of the most common causes of groin pain in athletes was considered adductor dysfunction. Surgical approach in groin pain in athletes remains a significant challenge. When we consider tendon surgery in groin pain, we consider adductor tenotomy. In adductor surgical pathology, there is not much in literature; there is not a consensus neither on the technique nor on the rehabilitation program to follow. The surgical techniques used to treat adductor pathology are percutaneous adductor longus tenotomy, open adductor longus tenotomy, adductor reattachment with suture anchors, and partial adductor release. We think that for the success of a rehabilitation program, it is important to know the characteristics of the patient and the specific surgical technique used. The postoperative complications included are adductor bruising, scrotal edema, wound infection, monolateral weakness in adduction, and painful scar. The majority of the rehabilitation protocols are not very specific and not well described, as well as surgical techniques are not homogeneous, and even some studies do not specify clearly the type of surgical approach made on the adductor. Postoperative rehabilitation consists of three separate phases. Phase I occurs during the first week after surgery. Patients are discharged home with full weight bearing using crutches for assistance. The goal is to allow the wound to heal to prevent reattachment of the adductor longus tendon. Phase II occurs during the second to fifth postoperative week depending on the type of surgery performed. The goals for this phase are to prevent reattachment, as well as the formation of excess scar tissue, and to improve flexibility of the adductor muscles. The phase III begins 6–12 weeks postoperative. The goal of this phase is a return to sports. We strongly recommend using the rating scales, either the ones we suggest or any other used by you. We recommend the Groin Disability Score (GDS). In addition, we advise a ten-point pain visual analog scale (VAS) and the four-point pain functional classification scales Puffer and Zachazewski.