Wakeboard accident, avulsion adductor longus

Clinical

The clinical course was similar to most other cases but nearly identical in all aspects to the case reported by Lands et al.^[2] The rider was brought on land, he presented with heavy pain as described. A medical investigation including palpation of inner thigh, groin, and suprapubic area was painful due to tissue damage and accompanying swelling. Passive abduction and adduction at this time were merely impossible, but the rider could walk with pain a few meter. For 2 days he rested.

Diagnostic

On day 4 after the injury an ultrasonography [Figure 1] was performed and on day 5 a magnetic resonance imaging, [Figure 2a and b].

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Figure 1

(a and b) Magnetic resonance imaging transversal showing complete osseous avulsion of adductor longus muscle, retraction 8 mm, hematoma

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Figure 2

Ultrasonography: Complete avulsion of adductor longus muscle, retracted muscle, hematoma

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Both imaging modalities showed a complete avulsion of the adductor longus and sartorius muscle with retraction of the adductor longus tendon and muscle of about 8 mm from the pubic bone. Hematoma had developed rapidly and progressed over 5 days down to popliteal fossa.

Therapy

The rider, after informed consent with experts, decided to apply conservative treatment, mainly because he learned that rehabilitation was a favorable option.

Since part of the pain was considered as consequence of inflammation a systemic treatment with prednisone was initiated (40 mg over 5 days, 20 mg over 5 days, and 10 mg for another 5 days). A general reduction of pain was noted 2 days after starting prednisone. The large cutaneous hematoma was treated with Hemoclar over 10 days. The swollen area left groin probably also due to the retracted muscle shrank satisfactorily, and most inner hematoma were resorbed after 12 days by inspection and palpation.

Rehabilitation exercises were started at day on day 5 after the accident consisting of physiotherapy following consultation with and personal advise by Thorborg et al., University of Copenhagen^[3] following the program published by Hölmich et al.^[4] and intensified using TheraBand.

Only 2 days after initiation of this program general daily complaints vanished. On day 17, the rider was nearly free of pain during daily life and when performing the exercise program. Muscular exercises were intensified at day 18 using an adductor weight training machine (Techno Gym) starting with 2o kg.

Based on the mentioned literature a complete regeneration could be expected after 6–10 weeks with a return to board sports and this was the achieved also in this case.

Thorborg, in his consulting, supposed that the avulsed muscle and his tendon may possibly find its way back.

Conclusion

In summary, a conservative treatment of a completely avulsed adductor longus muscle as first here described on a wakeboarder, seems favorable over operative interventions, using an intense accelerated rehabilitation program. Early prednisone therapy, not reported so far, may be a valuable and effective intervention for pain and inflammation reduction with less risk than using nonsteroidal drugs which may intensify bleeding risk and hematoma forming.