Heterotopic Ossification in Complete Adductor Longus Tears: A Retrospective Analysis of Associated Factors and Surgical Outcomes

Purpose: Heterotopic ossification (HO) is a rare but recognized complication of adductor longus tears, and the factors that predispose patients to its development are not well characterized. The purpose of this study was to identify factors associated with the development of HO following adductor longus tears and to describe outcomes after surgical management. Methods: A retrospective review was conducted of 132 patients surgically treated for adductor longus tears by a single surgeon between January 2016 and January 2025. Patients were classified by tear severity (partial versus complete) and by symptom chronicity (acute versus chronic, using a six-month cutoff). HO was identified on MRI or CT. All patients had failed prior conservative management and underwent surgical excision, with pain and range of motion assessed at six months postoperatively. Results: Of the 132 patients, 87 had partial tears and 45 had complete tears. HO was identified in 10 of 45 patients (22%) with complete tears and in none of the 87 patients with partial tears. Among patients with HO, 60% had acute injuries and 40% had chronic injuries. Surgical excision led to significant improvement in pain and range of motion at six months in all patients. Conclusion: HO following adductor longus injury occurred exclusively in complete avulsions, regardless of injury chronicity, and surgical excision was associated with substantial functional recovery.