Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings

Osteitis pubis and assessment of bone marrow edema at the pubic symphysis with MRI in an elite junior male soccer squad

OBJECTIVES

To assess bone marrow edema at the pubic symphysis with magnetic resonance imaging (MRI), and its relation to training and osteitis pubis in an elite group of junior soccer players.

SETTING

Soccer players on scholarship at the Australian Institute of Sport (AIS).

PATIENTS

Nineteen players from an elite junior men's soccer squad. INTERVENTION/ASSESSMENT: Serial MRI examinations of the pubic symphysis over a 4-month training and playing period, training session questionnaire, and review of clinical diagnosis, investigations, and records on presentation of athletes with groin pain at the Department of Sports Medicine.

MAIN OUTCOME MEASURES

Assessment of bone marrow edema (4-point scale) on MRI scans, review of athlete questionnaires, and review of clinical records.

RESULTS

Initial MRI scans showed moderate to severe bone marrow edema at the pubic symphysis in 11 of the 18 asymptomatic players. There was a greatly decreased risk of developing groin pain (osteitis pubis) with more training prior to entry of the AIS soccer program (odds ratio per 4 sessions of training, 0.003). The correlation between initial bone marrow edema grading and pre-AIS training was small. The increase in bone marrow edema grading from baseline over the scans was 0.5 (90% CL, 0.4).

CONCLUSIONS

Substantial amounts of bone marrow edema at the pubic symphysis can occur in asymptomatic elite junior soccer players, but it is only weakly related to the development of osteitis pubis. Progressing training loads more slowly in athletes presenting with low current training loads may be a useful strategy for the prevention of osteitis pubis in junior soccer players.

Abnormalities in and Around the Hip: MR Imaging Versus Sonography

Sonography and MR imaging should be considered complementary rather than competing modalities. They demonstrate similar abnormalities of the soft tissues, but MR imaging is able to demonstrate intraosseous and articular abnormalities and offers a better anatomic overview because of its larger field of view, whereas sonography offers dynamic evaluation and can provide real-time guidance for percutaneous procedures. Both of these modalities have roles in the imaging evaluation of injuries in and around the hip.

MR Imaging of Sports-Related Groin Pain

With increasing participation in professional and recreational athletics, activity-limiting pelvic and groin pain presents a growing challenge for patients and health care providers. The causes of musculoskeletal-related groin pain among athletes are diverse, with considerable overlap in history and physical examination findings. Pubalgia is a clinical diagnosis invoked when no more specific cause ofa patient's symptoms can be determined on history and physical examination. In many cases, dedicated MR imaging of the hip and pelvis can provide a prompt and specific diagnosis, which allows for early treatment and return to participation.

Groin pain in footballers: the association between preseason clinical and pubic bone magnetic resonance imaging findings and athlete outcome

BACKGROUND

Groin pain and tenderness are common in athletes from a variety of codes of football, but little attention has been directed to the influence of magnetic resonance imaging and such clinical findings on athlete participation.

HYPOTHESIS

Preseason groin pain, tenderness, and magnetic resonance imaging findings such as pubic bone marrow edema are associated with restricted training capacity and missed games.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Fifty-two Australian footballers in the national competition were recruited. Preseason groin pain and focal tenderness were recorded, and magnetic resonance imaging of the groin was performed within 1 week of examination. Training restriction and games missed owing to groin pain were documented during the subsequent season.

RESULTS

Magnetic resonance imaging showed pubic bone marrow edema in 19 of 52 (37%) footballers and linear parasymphyseal T2 hyperintensity in 16 of 52 (31%) footballers. Groin pain restricted training during the season in 22 of 52 (42%) footballers, and 9 of 52 (17%) footballers missed at least 1 game. Preseason pain (P = .0004), pubic bone tenderness (P = .02), and linear parasymphyseal T2 hyperintensity (P = .01) were associated with restricted training capacity during the subsequent season. Preseason groin pain (P = .03) was associated with missed games, but magnetic resonance imaging findings were not.

CONCLUSION

Preseason pubic bone marrow edema, groin pain, and linear parasymphyseal T2 hyperintensity were associated with training restriction, but only preseason groin pain was associated with missed games.