Image Interpretation: A clear disruption of the common adductor tendon origin was appreciated at the pubic symphysis with marked cortical irregularity. Specifically, the deep fibers of the adductor longus tendon were disrupted, characterized by a large anechoic region measuring 1.87 x 1.56 x 0.55cm. The superficial tendon fibers appeared intact. Subtle hyperemia and significant cortical irregularity were also noted at the adductor tendon origin and sonopalpation reproduced the patient's pain. The distal rectus abdominus tendon was intact. The pubic aponeurotic plate was intact. Impression: Near complete tear of the adductor longus tendon origin measuring 1.56 x 0.55 x 1.87 cm without avulsion.

Teaching Pearl: Core muscle injuries (CMI) include injury to structures between the chest and mid-thigh. Further classification of these injuries based on anatomical position around the pubic bone allows for a better understanding of the pathophysiology of the injuries along with a more accurate diagnosis and treatment plans. Subcategories of groin pain include adductor- related, inguinal-related, pubic-related, and iliopsoas-related groin pain. Specific musculoskeletal patterns are the basis for decision making for diagnosis and treatment options, nonsurgical vs surgical management, and overall outcomes. Our case describes an athlete with an adductor-related injury with an isolated near-complete tear of the adductor longus. The injury likely occurred during the eccentric stretch placed on the adductors at maximum depth while performing a barbell back squat. CMIs are highly prevalent among athletes engaged in sports that demand frequent kicking, twisting, change of direction and rapid acceleration/deceleration due to the demand placed on these muscles for stabilizing and supporting the body during dynamic movements. Considering the pelvic/central stability these muscles provide, injuries can have an impacted on daily activities such as walking, climbing stairs, and rising from a chair, as well as coughing, urinating, and defecating. Ultrasound is a valuable tool for dynamic assessment of soft tissue injury in the evaluation of the Athletic groin. Patient positioning for optimal ultrasound assessment should include the leg in a position that readily exposes the medial hip to thoroughly evaluate the appropriate structures while keeping the patient comfortable. This may include flexion and external rotation (frog leg). An alternative position for patient comfort can include lateral recumbent but likely requires changes in position when attempting to visualize the proximal and anterior core regions. Adductor tear will show discontinuity of the echogenic perimysial striae at the myotendinous or myofascial interface. Serial US examinations can be used to monitor progress and healing of the muscle tissue. This, along with physical exam, can be used as a predictor for a return to play timeline. Poor, Alexander E. MD1; Roedl, Johannes B. MD, PhD2; Zoga, Adam C. MD2; Meyers, William C. MD1. Core Muscle Injuries in Athletes. Current Sports Medicine Reports 17(2):p 54-58, February 2018. | DOI: 10.1249/JSR.0000000000000453 Campbell R. Ultrasound of the athletic groin. Semin Musculoskelet Radiol. 2013;17(1):34-42. doi:10.1055/s-0033-1333912 Ryan J, DeBurca N, Mc Creesh K. Risk factors for groin/hip injuries in field-based sports: a systematic review. Br J Sports Med. 2014;48(14):1089-1096. doi:10.1136/bjsports-2013-092263