Surgical and Conservative Management of Adductor Tendinopathy Yield Comparable Outcomes and Complications: A Systematic Review

Background Adductor injuries are common among athletes and can cause a significant loss in playing time. While previous reviews have investigated the efficacy of both conservative and surgical approaches in managing adductor tendinopathy, they have not provided comprehensive assessments of outcome measures, complication rates, or the impact of injury chronicity. The purpose of this review was to evaluate treatment modalities for adductor tendinopathy and determine the superiority of conservative or surgical approaches with a specific focus on return-to-sport (RTS) rates. Methods Three online databases were queried in September 2023 to identify clinical studies reporting on treatments for adductor tendinopathy. Data aggregation encompassed information pertaining to the etiology and chronicity of injuries, interventions, clinical outcomes, RTS time and rates, and complications. Results Nineteen studies published between 2005 and 2021 involving a total of 730 patients with a mean age of 34.8 years were included. Six studies assessed acute injuries, while thirteen examined chronic injuries. Surgical treatment for acute tendinopathy reported a RTS within 12-20.6 weeks, with 85.7-100% rate of returning to the preinjury sports level, while conservative treatment led to a RTS within 6.1-12.7 weeks. Surgical treatment for chronic tendinopathy led to a RTS between 9.21-18 weeks, while conservative treatment RTS ranged between 12.8-17.3 weeks. The complication rate was 16.6% for acute and up to 20% for chronic tendinopathy. Conclusion Conservative and surgical treatments lead to improved clinical and functional outcomes for both acute and chronic tears, facilitating patients to return to sports at their pre-injury level. Conservative care demonstrates comparable outcomes to surgery in acute partial tears, potentially expediting the return to play. In chronic injuries, surgical intervention may decrease the risk of persistent pain and result in slightly higher return-to-play rates.