Adductor Longus Tenotomy & the BKFO Test

Study Overview
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Brief Summary
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The bent knee fall out test (BKFO) is a common test for hip adductor flexibility. It is unknown whether the BKFO actually tests the the adductors or potentially hip range of motion instead. In this study, the BKFO test is performed in the operating theater before and after an adductor longus tenotomy.

Detailed Description
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Adductor-related groin pain is the most common type of groin pain in athletes, and pain at the proximal adductor longus insertion is a key finding in the diagnosis of longstanding groin pain. Tightness or shortening of the adductor longus is considered both a cause and effect of pain, that can lead to increased tension at the proximal insertion, thus playing a role in the persistence of longstanding adductor-related pain. For patients who do not respond sufficiently to non-surgical procedures, an adductor longus tenotomy is a surgical option that is considered to reduce tension at the proximal adductor longus insertion assisting in reduction of pain and return to sport. The bent knee fall out test (BKFO) is one of the most commonly used tests to test adductor flexibility. This test involves a combined hip movement with hip flexion, abduction, and external rotation, and a high result is generally considered to be related to adductor muscle tightness, specifically that of the adductor longus. It is uncertain whether the BKFO test is actually measuring adductor muscle flexibility or hip joint range of motion, as the test results may also be affected by a femoral head cam morphology. A slightly different test, called the Patrick FABER's test, involves a similar movement and is mainly used as a hip joint pain provocation test. By cutting the adductor longus tendon, thereby removing the effect of potential adductor longus tightness, it will be possible to show if and how much the flexibility of this muscle affects the BKFO test results. This will assist in future considerations of what this test is actually testing. The aim of this study is to investigate the immediate effect of an adductor longus tenotomy on the results of the bent knee fall out test.

Official Title
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The Effect of an Adductor Longus Tenotomy on the Bent Knee Fall Out Test

Conditions
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Adductor Tendinitis

Intervention / Treatment
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* Other: No intervention assigned as part of this study.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: adults (>18 years old) athletes (recreational or elite) clinical diagnosis of adductor-related groin pain patients undergoing unilateral or bilateral adductor longus tenotomy by one general surgeon. Exclusion Criteria: No specific exclusion criteria were present other than refusal to participate in the study.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: No intervention assigned as part of this study.|The intervention included in this study is part of routine medical care, and not assigned as a result of study participation. This study includes only the addition of a measurement; the bent knee fall out test. Therefore, we believe this study design is observational, and in line with the provided observation study design definition: Observational: studies in human beings in which biomedical and/or health outcomes are assessed in predefined groups of individuals. Participants in the study may receive diagnostic, therapeutic, or other interventions, but the investigator does not assign specific interventions to the study participants. This includes when participants receive interventions as part of routine medical care, and a researcher studies the effect of the intervention. See uploaded study protocol for further details.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the Bent Knee Fall Out test | The patient lies supine on the surgical table with app. 90° knee flexion, 45° hip flexion, and the feet together and the hips in external rotation (also known as the frog-leg position. Standardization of position is achieved by flexing one leg first, so the medial malleolus is placed next to the medial knee joint line of the contra-lateral leg. The knee is then moved laterally, externally rotating the hip with the plantar surface placed towards the contra-lateral leg. The contra-lateral leg is then flexed, and the plantar surfaces of the feet are aligned. The distance between the most distal point on the head of the fibula and the surface of the surgical table is measured using a rigid tape measure and distance is recorded in cm to the nearest 0.5 cm | Baseline pre-surgery and immediately after the surgery. |