The adductor longus tendon is the most palpable structure at the medial groin, arising from the pubic body as a clearly defined cord that is easily palpated at the pubic symphysis. It is the most commonly strained groin tendon in kicking sports, with the proximal musculotendinous junction and pubic insertion being the two most frequent injury sites. Adductor longus pubic symphysis insertional pathology in the context of athletic pubalgia or sports hernia represents a specific clinical entity distinct from the more common myotendinous strain.
| Muscle | |
|---|---|
| Attachment | Pubic body just below the pubic crest at the pubic symphysis |
Groin force transmission; hip adduction; medial femoral triangle boundary
The adductor longus attaches through a fibrocartilaginous enthesis that blends with the rectus abdominis insertion in a shared pubic aponeurosis, the site of athletic pubalgia (sports hernia), where repetitive shear forces at the pubic symphysis cause pain without a true hernia. It is the most commonly injured groin muscle in football and ice hockey, and MRI distinguishes musculotendinous junction strains from enthesopathy and the rare complete avulsion. The adductor squeeze test in varying hip flexion angles helps localise pain to the adductor longus versus the hip flexors or pubic symphysis. Overuse enthesopathy is managed with progressive adductor strengthening, and return to sport requires pain-free resisted adduction at full strength. Complete proximal avulsion in athletes is usually repaired surgically within the first few weeks.
Proximal musculotendinous junction or pubic insertion tear producing medial groin pain with resisted adduction, managed with progressive adductor loading rehabilitation.
Pubic aponeurosis pathology at the combined adductor-rectus abdominis insertion producing exertional groin pain without a true hernia, managed with physiotherapy and occasionally surgical exploration for refractory cases.
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