Arian Foster groin injury: Top 10 questions answered

What is going on with Arian Foster? How does a premiere NFL running back make one cut in the first practice of training camp and end up needing potential surgery? First of all, let me be clear that I have not examined Foster or seen his MRI. As many of you know, I often opine on diagnosis off of injury video. In this case, I have not seen and I am not aware of any available film (maybe HBO will have it when Hard Knocks debuts next week). I am purely going off of limited media reports, history of the player and my two decades of NFL experience as a team physician. I call it “insider knowledge” of professional football sports medicine, but it certainly is not “insider information”. I do know the Texans medical staff well, like I do most of the medical personnel in the league; however, I would not insult a medical professional’s integrity by asking for injury specifics on a player. As a practicing orthopedic surgeon, when I am consulted on a NFL athlete, I no longer tweet or write on his injury as that would be unfair, unethical and against HIPAA rules. Enough of the disclaimers.
  1. What is Arian Foster's injury?
Reports say groin, but what does groin mean? It can mean one of several adductor muscles/tendons, hip injuries, the rectus abdominis or associated core muscle. Most commonly it is the adductor group that is injured. This affects the ability to accelerate and cut, two obvious key requirements for a running back.
  1. Will Arian Foster need groin MUSCLE repair surgery?
Unequivocally, no. He will not have groin muscle repair surgery. Even if the muscle is torn in two, it cannot be repaired. Healthy muscle tissue won’t hold suture; torn muscles can’t either. If he has a groin muscle tear it usually is referring to the adductor group. Undoubtedly such an injury will be allowed to heal without surgery. It is likely that platelet rich plasma (or even stem cell) injections could be used.
  1. Will Arian Foster need groin TENDON repair surgery?
Highly unlikely that a groin tendon torn on one cut would ever need suturing. As I tweeted initially, it is very unusual to need to repair any acute adductor tear. Unlike muscle, tendon can be repaired as it is hearty enough to hold stitches. However, there usually is little reason to sew it. The adductor longus tendon is the most common one to rupture. Even when this is retracted (pulled away) by several centimeters it usually scars in and heals well on its own. I have treated NFL running backs non-surgically with this injury and they have gone on to full recovery. The only scenario of a groin tendon repair is in the case of a complete avulsion where multiple adductor tendons pull off the pelvis usually with a piece of bone attached. This just doesn’t happen very often. In fact, I do not recall a case of it happening to me in 20 years of NFL experience.
  1. Are the early reports of Arian Foster needing groin surgery incorrect?
Not necessarily as I am not saying he definitely won’t need surgery. I am only saying he won’t need groin/adductor muscle repair surgery. He is very unlikely to need groin/adductor tendon repair surgery. He could need other types of groin surgery or he could go with conservative care.
  1. What is the most common surgery performed on an adductor?
Believe it or not, the procedure most often performed on the groin is a release or lengthening surgery where the adductor is too tight. In some ways, a chronic groin problem is self-treated by a tear. It would not typically make sense to repair a chronic adductor tendon that has torn.
  1. Will Arian Foster need surgery of any kind?
If he does need surgery, it will likely be sports hernia surgery. This is sometimes referred to as groin surgery or core muscle repair, but it is much different than adductor repair surgery described above. This procedure gives quicker recovery as one typically is not waiting for structural healing. If surgery is needed, this is the one that Texans fans want to hope for.
  1. Didn’t Arian Foster have groin issues last season?
Yes, and this is why he might need sport hernia type surgery to treat his chronic groin issues. He was injured in a Week 9 loss to the Eagles that subsequently limited him last season. The current groin injury may be a continuation of last year's issues which may lead the Texans to consider sports hernia surgery now. It may be smarter to cut their losses now, as opposed to dealing with groin issues all season long.
  1. When will Arian Foster return to play?
He could return as early as 4-6 weeks; however, the Texans might play it safe with their bell cow running back and wait an extra week or two to avoid season long re-aggravation. This estimate is applicable to non-operative groin treatment as well as sports hernia surgery. If he truly needed groin tendon repair surgery, Foster would miss at least three months and the season would be in some jeopardy. This is unlikely and would be the worst-case scenario.
  1. Will Arian Foster return to be 100%?
I believe he will. The only question is when. Fortunately, this injury is not likely to end his career. However, this injury may be part of the wear and tear that eventually catches up to all NFL running backs.
  1. Didn’t teammate Jadeveon Clowney have surgery on his groin too?
Yes. Prior to his rookie year, the number one overall pick had mid-June sports hernia surgery. He made it back for the first training camp practice five weeks later, though his rehab continued. His subsequent knee injury requiring microfracture surgery was not directly related to the groin injury. In no way am I second-guessing the quality Texans medical staff. If anything I am first-guessing, as we have yet to hear the treating doctors chime in. In fact, I have utmost confidence that his team doctors will make the right decision for the player and the team. Here, I am only giving general parameters based on my medical experience. Only his treating physicians know the full story right now. Follow on Twitter: @ProFootballDoc
Dr. David Chao
Two decades of NFL team physician experience including two Super Bowls and two Pro Bowls. Providing unique perspective to injuries and the NFL sideline/locker room. Successful orthopedic surgery and sports medicine practice in Southern California.

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