ADDUCTOR MUSCLE INJURY DUE TO STRAIN: DIAGNOSTIC AND THERAPEUTIC APPROACH

Abstract

Introduction: Adductor muscle injury due to strain is a frequent cause of acute groin pain in athletes and physically active individuals, particularly in sports involving sprinting, kicking, rapid acceleration, deceleration, and multidirectional movements. Accurate diagnosis is clinically important because adductor strain overlaps with other causes of groin pain and may range from minor myofascial injury to complete proximal tendon avulsion. Objective: The main objective of this systematic review was to evaluate the current evidence regarding diagnostic and therapeutic strategies for adductor muscle injury due to strain. Secondary objectives were to describe epidemiology and biomechanics, assess clinical and imaging methods, compare conservative and surgical treatment, evaluate rehabilitation and return-to-play criteria, and identify limitations in the current literature. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and the International Clinical Trials Registry Platform. Studies were eligible when they evaluated adductor strain, acute adductor-related injury, diagnostic imaging, conservative treatment, surgery, rehabilitation, prevention, recurrence, or return to play. Risk of bias was assessed using RoB 2, ROBINS-I, and QUADAS-2 according to study design, and certainty of evidence was evaluated using the GRADE framework. A narrative synthesis was performed because of clinical and methodological heterogeneity. Results and Discussion: Twenty studies were included in the final review. The evidence supports a clinical diagnosis based on injury mechanism, pain location, palpation, resisted adduction testing, and functional assessment, with magnetic resonance imaging used selectively for anatomical grading, tendon involvement, severe injury, uncertain diagnosis, or prognostic clarification. Conservative treatment was appropriate for most strains and emphasized progressive loading, restoration of eccentric adduction strength, kinetic-chain control, and criteria-based return to play. Surgical treatment was reserved for selected complete proximal avulsions with relevant retraction, persistent disability, or failure of structured rehabilitation. Eccentric adductor strengthening, particularly through Copenhagen-type exercise programs, showed preventive value and should be integrated into rehabilitation and secondary prevention. Conclusion: Adductor strain should be managed through an individualized, evidence-based, and multidisciplinary approach. Most patients recover with structured conservative rehabilitation, while surgery should be considered only in selected severe injuries. Return to play should be guided by symptoms, strength, sport-specific function, and recurrence risk rather than by time alone.