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Salman R, Albar A, Kan JH. MR imaging spectrum of adolescent pubic symphyseal injuries/athletic pubalgia. Pediatr Radiol 2024; 54:1270-1280. [PMID: 38736018 DOI: 10.1007/s00247-024-05946-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) findings associated with athletic pubalgia are well documented in the adult literature. OBJECTIVE To describe the spectrum of MRI findings in adolescents with pubic symphyseal injuries/athletic pubalgia. MATERIALS AND METHODS This is an institutional review board approved, retrospective study of all patients < 18 years who were referred for MRI, over the last 10 years. Two pediatric musculoskeletal radiologists evaluated the MRI in consensus for the following findings: Chronic Salter-Harris (SH)-I equivalent fracture or asymmetric parasymphyseal ossific fraying, non-retractile muscular tear or retraction, and edema of the aponeurosis and arcuate ligament. Radiographs were also reviewed for Risser stage. RESULTS Fifteen patients were identified (100% male, median age 17 years, IQR 16-17.6). Most patients (14/15, 93%) had either asymmetric parasymphyseal ossific fraying (4/15, 27%) or chronic SH-1 equivalent fracture (10/15, 67%) of the pubic symphysis, and all patients (15/15, 100%) had aponeurotic and arcuate ligament edema. Few patients had rectus abdominis muscular retraction (2/15, 13%), non-retractile muscular tear of the rectus abdominis (2/15, 13%), and/or adductor muscle (4/15, 27%). Risser stage was as follows: stages 0 (13%), 3 (7%), 4 (47%), and 5 (33%). The injuries in our limited data set were independent of skeletal maturity with no statistically significant association between any of the MRI findings and Risser stage. CONCLUSION The MR imaging spectrum of adolescent athletic pubalgia differs from the described findings in adults due to skeletal immaturity. The cleft sign described in adults manifests in adolescents as asymmetric parasymphyseal ossific fraying and chronic SH-1 equivalent fractures.
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Affiliation(s)
- Rida Salman
- Department of Radiology, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Dr, Columbus, 43205, OH, USA.
| | - Abeer Albar
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - J Herman Kan
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Thorarinsdottir S, Amundsen R, Larmo A, Pedersen R, Andersen TE, Bahr R, Møller M. Groin injuries in women's premier league football in Norway: A two-season prospective cohort study describing clinical and imaging characteristics. Scand J Med Sci Sports 2024; 34:e14611. [PMID: 38534061 DOI: 10.1111/sms.14611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/13/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To describe the prevalence, incidence, and burden of groin injuries in the Norwegian women's premier football league and to describe their clinical and imaging characteristics. METHODS During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported groin injuries weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H2). We calculated weekly prevalence, incidence, and burden of groin injuries. The team physical therapists classified the player-reported injuries based on the Doha classification system. Injuries with more than 3 days' time loss or reported in 2 consecutive weeks were eligible for magnetic resonance imaging (MRI). RESULTS On average, 3.9% (95% CI: 3.4-4.4) of players reported a groin injury at any time; of which 78% caused time loss. The incidence rate was 1.6 injuries/1000 h (95% CI: 1.3-2.0) and their burden was 11 days lost/1000 h. The physical therapists examined 67 of 124 player-reported groin injuries (53%). Adductor-related injury was most common (55%) followed by iliopsoas (15%) and rectus femoris-related (12%). Pubic-related injuries caused most time loss (median: 24 days, IQR: 5-133). In this study, 42 injuries were investigated with MRI; 8 (19%) showed no changes, 6 (14%) an acute musculotendinous lesion, and 32 (76%) a nonacute finding (e.g., central symphyseal disc protrusion, tendinopathies). CONCLUSION The incidence rate and burden of groin injuries were high. Adductor-related injuries were most common, but pubic-related injuries caused most time loss. Most MRI examinations demonstrated nonacute findings.
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Affiliation(s)
- Solveig Thorarinsdottir
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Roar Amundsen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | | | | | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- The Norwegian FA Medical Centre (Idrettens helsesenter), Oslo, Norway
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Merete Møller
- Oslo Sports Trauma Research Center, Institute of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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3
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Ooi MWX, Marzetti M, Rowbotham E, Bertham D, Robinson P. MRI findings in athletic groin pain: correlation of imaging with history and examination in symptomatic and asymptomatic athletes. Skeletal Radiol 2024:10.1007/s00256-024-04603-9. [PMID: 38302788 DOI: 10.1007/s00256-024-04603-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To determine differences in prevalence and diagnostic accuracy of MRI findings between asymptomatic athletes and athletes with longstanding groin pain. MATERIALS AND METHODS One hundred twenty-three adult male athletes were approached with 85 consecutive athletes recruited. Group 1 (symptomatic, n = 34) athletes referred for longstanding groin pain (insidious onset, > 3 weeks duration). Group 2 (control, n = 51) athletes referred for injuries remote from the pelvis and no groin pain in the last 12 weeks. All referrers completed a clinical examination proforma documenting absence or presence of pelvis and hip abnormality. All patients completed the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire and underwent a 3T MRI groin and hip protocol. MRIs were scored independently by two musculoskeletal radiologists blinded to clinical details. Statistical analysis was performed to evaluate associations between MRI findings, inter-reader reliability, clinical examination and HAGOS scores. RESULTS Pubic body subchondral bone oedema, capsule/aponeurosis junction tear and soft tissue oedema were more prevalent in the symptomatic group (p = 0.0003, 0.0273 and 0.0005, respectively) and in athletes with clinical abnormality at symphysis pubis, adductor insertion, rectus abdominis, psoas and inguinal canal (p = 0.0002, 0.0459 and 0.00002, respectively). Pubic body and subchondral oedema and capsule/aponeurosis tear and oedema significantly correlated with lower (worse) HAGOS scores (p = 0.004, 0.00009, 0.0004 and 0.002, respectively). Inter-reader reliability was excellent, 0.87 (range 0.58-1). Symphyseal bone spurring, disc protrusion and labral tears were highly prevalent in both groups. CONCLUSION Clinical assessment and MRI findings of pubic subchondral bone oedema and capsule/aponeurosis abnormality appear to be the strongest correlators with longstanding groin pain.
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Affiliation(s)
- Michelle Wei Xin Ooi
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Matthew Marzetti
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Department of Medical Physics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Emma Rowbotham
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dominic Bertham
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip Robinson
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Groin Pain in Athletes. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Bisciotti GN, Auci A, Bona S, Bisciotti A, Bisciotti A, Cassaghi G, DI Marzo F, DI Pietto F, Eirale C, Panascì M, Parra F, Zini R. Long-standing groin pain syndrome in athletic women: a multidisciplinary assessment in keeping with the italian consensus agreement. J Sports Med Phys Fitness 2021; 62:1199-1210. [PMID: 34931789 DOI: 10.23736/s0022-4707.21.13322-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Long-standing groin pain syndrome (LSGPS) is a form of groin pain syndrome in which the cohort of symptoms reported by patients is experienced for a long period, typically for over 12 weeks, and is recalcitrant to any conservative therapy. The aim of this prospective epidemiological study was to describe the clinical causes of LSGPS in 37 female athletic subjects in Italy through the Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athletes classification and guidelines. METHODS Thirty-seven female athletes affected by LSGPS were evaluated following the guidelines issued by the Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment of groin pain in athletes. RESULTS In the considered population, each patient presented only one pathological cause for LSGPS. The most frequent aetiologies were inguinal pathologies (54.05% of the cases), acetabular labrum tear (18.92%) and pelvic floor disorders (8.11%). Adductor tendinopathy represented only 2.70% of cases. CONCLUSIONS Female athletic patients affected by LSGPS show a similar incidence of inguinal and hip pathologies as in male populations. However, these clinical situations do not seem to be associated in women unlike in the male population. This difference is probably due to particular anatomical differences related to gender. For this reason, women affected by LSGPS represent an important subset of patients. Moreover, adductor tendinopathy is probably overrated as an etiopathogenetic source of LSGPS in women.
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Affiliation(s)
- Gian Nicola Bisciotti
- Paris Saint Germain FC, Paris, France - .,Kinemove Rehabilitations Center, Pontremoli, Massa Carrara, Italy -
| | - Alessio Auci
- Azienda USL Toscana Nord-Ovest, Massa Carrara, Italy
| | - Stefano Bona
- Humanitas Resarch Institute, Rozzano, Milan, Italy
| | | | - Andrea Bisciotti
- Kinemove Rehabilitations Center, Pontremoli, Massa Carrara, Italy
| | | | | | | | | | | | - Federica Parra
- Kinemove Rehabilitations Center, Pontremoli, Massa Carrara, Italy
| | - Raul Zini
- Università degli Studi di Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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6
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Dallaudiere B, Sylvain B, Poussange N, Reboul G, Silvestre A, Meyer P, Hocquelet A, Pesquer L. Ultrasound feature variants of the adductor longus tendon in asymptomatic sportive subjects: Management implications. Eur J Radiol 2021; 144:109928. [PMID: 34562742 DOI: 10.1016/j.ejrad.2021.109928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/28/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The potential contribution of ultrasound (US) to diagnose adductor longus (AL) tendinopathy in athletic pubalgia requires clarification. We investigate US findings from AL tendons of asymptomatic participants to identify the range and prevalence of common US features not associated with groin pain. METHODS We consecutively enrolled 45 volunteers physically active participants with no history of groin pain. US features of bilateral AL tendons were investigated and recorded by two experienced musculoskeletal radiologists (MSKR) in accordance with a defined ultrasound protocol. Two other MSKRs retrospectively and independently analyzed all US images. RESULTS Ninety AL tendons from 45 participants (4/45 women) were imaged (average age: 35 years ±14.6; dominant side: 37/45 (82.2%) right, 8/45 (17.8%) left). Abnormalities on US were found in all 45 (100%) AL tendons, including: abnormal echogenicity (98.9%/100% respectively according to reader), loss of fibrillar structure (92.2%/97.8%), irregularities of the superficial paratendon (23.3%/30%), calcifications (22.2%/25.5%), and cortical erosion (52%/55.5%), with excellent inter-observer assessment. No AL tears or hyperemia at color Doppler were detectable. CONCLUSIONS AL tendon abnormalities were identified via US in 100% of our asymptomatic athletes. The significance of these US findings should be interpreted cautiously with respect to clinical presentation. On the other hand, there is a need for supplemental investigation into the clinical relevance of US AL tendon tears not present in the present asymptomatic athlete population.
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Affiliation(s)
- Benjamin Dallaudiere
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France; Département d'imagerie musculo-squelettique, centre hospitalier universitaire Pellegrin, place Amélie-Léon-Rabat, 33000 Bordeaux, France.
| | - Bise Sylvain
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Nicolas Poussange
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Gilles Reboul
- Centre de chirurgie orthopédique et sportive, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Alain Silvestre
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Philippe Meyer
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Arnaud Hocquelet
- Service de radiologie et d'imagerie diagnostique et interventionnelle, CHU Vaudois, 1011 Lausanne, Suisse
| | - Lionel Pesquer
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
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7
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Serner A, Hölmich P, Arnaiz J, Tol JL, Thorborg K, Weir A. One-Year Clinical and Imaging Follow-up After Exercise-Based Treatment for Acute Complete Adductor Longus Tendon Avulsions in Athletes: A Prospective Case Series. Am J Sports Med 2021; 49:3004-3013. [PMID: 34161743 DOI: 10.1177/03635465211015996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Complete avulsions of the adductor longus tendon are serious injuries, yet we have few data to inform clinical decisions on management. Previous studies are limited by a lack of detailed follow-up. PURPOSE To describe detailed clinical and imaging measures 1 year after complete proximal adductor longus avulsion injuries in athletes who received exercise-based treatment. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 16 adult male competitive athletes were included in this study <7 days after an acute adductor longus tendon avulsion injury. All athletes were advised to complete a supervised standardized criterion-based rehabilitation protocol. Standardized clinical examination, a modified Copenhagen Hip and Groin Outcome Score (HAGOS), the Oslo Sports Trauma Research Centre Overuse Injury Questionnaire (OSTRC-O), and detailed magnetic resonance imaging (MRI) assessment were performed after inclusion, on the day of completion of the treatment protocol (return to sport), and at 1-year follow-up after injury. RESULTS One player was lost to follow-up. Median return-to-sport time was 69 days (interquartile range [IQR], 62-84). One player had an early reinjury and performed an additional rehabilitation period. One-year follow-up was completed a median from 405 days (IQR, 372-540) after injury. The median HAGOS score was 100 for all subscales (IQRs from 85-100 to 100-100), and the median OSTRC-O score was 0 (IQR, 0-0). The median range of motion symmetry was 100% (IQR, 97%-130%) for the bent-knee fall-out test and 102% (IQR, 99%-105%) for the side-lying abduction test. Side-lying eccentric adduction strength symmetry was 92% ± 13% (mean ± SD), and median supine eccentric adduction strength symmetry was 93% (IQR, 89%-105%). MRI results at 1-year follow-up showed that from the original complete discontinuity in all cases, 10 athletes (71%) had partial tendon continuity, and 4 (29%) had complete tendon continuity. CONCLUSION Nonsurgically treated athletes with a complete acute adductor longus avulsion returned to sport in 2 to 3 months. At the 1-year follow-up after injury, athletes had high self-reported function, no performance limitations, normal adductor strength and range of motion, and signs of partial or full tendon continuity as shown on MRI. This indicates that the primary treatment for athletes with acute adductor longus tendon avulsions should be nonsurgical as the time to return to sport is short, there are good long-term results, and there is no risk of surgical complications.
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Affiliation(s)
- Andreas Serner
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Per Hölmich
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Javier Arnaiz
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Amsterdam University Medical Centers, Academic Medical Center, Amsterdam Movement Sciences, Academic Center for Evidence-Based Medicine, Amsterdam IOC Center, Amsterdam Collaboration for Health and Safety in Sports, Amsterdam, the Netherlands.,Medical and Performance Department, AFC Ajax, Amsterdam, the Netherlands
| | - Kristian Thorborg
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Adam Weir
- Erasmus MC Center for Groin Injuries, Department of Orthopaedics, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.,Sport Medicine and Exercise Clinic Haarlem (SBK), Haarlem, the Netherlands
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8
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Bisciotti GN, Auci A, Bona S, Bisciotti A, Bisciotti A, Cassaghi G, DI Marzo F, DI Pietto F, Eirale C, Panascì M, Parra F, Zini R. A multidisciplinary assessment of 320 athletes with long-standing groin pain syndrome in keeping with the Italian consensus agreement: the high incidence and the multiple causes of inguinal and hip pathologies and pubic osteopathy. J Sports Med Phys Fitness 2021; 61:960-970. [PMID: 34296841 DOI: 10.23736/s0022-4707.20.11575-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Groin pain syndrome is an important and increasing problem in numerous sports (e.g. soccer, football, ice hockey, handball and rugby). Long-standing groin pain syndrome is a form of groin pain syndrome in which the cohort of symptoms reported by the patient is experienced for a long period, typically for over 12 weeks, and is recalcitrant to any conservative therapy. Long-standing groin pain syndrome is potentially career-ending for elite athletes. METHODS A descriptive epidemiological study was carried out on 320 athletes (290 men and 30 women) affected by long-standing groin pain syndrome, following the Guidelines issued by the Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment of groin pain in athlete. RESULTS Amongst the clinical tests for inguinal pathologies, only the External Inguinal Ring Exploration proved conclusive (sensitivity: 0.97; specificity: 0.95; positive predictive value: 0.98; negative predictive value: 0.90; likelihood ratio: 19.4). In testing for adductor tendinopathies, only the Isometric Squeeze with flexed knee and distal resistance (sensitivity: 0.86; specificity: 0.45; positive predictive value: 0.48; negative predictive value: 0.85; likelihood ratio: 5.7) and the Palpatory Test at the pubic insertion of the adductor longus (sensitivity: 0.93; specificity: 0.89; positive predictive value: 0.96; negative predictive value: 0.79; likelihood ratio: 8.5) proved, respectively, useful at times and moderately useful. Among the tests for hip pathologies, only the Flexion Abduction External Rotation Test was seen to be conclusive (sensitivity: 0.90; specificity: 0.93; positive predictive value: 0.98; negative predictive value: 0.72; likelihood ratio: 12.9). In the male population on average, long-standing groin syndrome presents either a single cause or multiple causes in respectively 74% and 26% of cases. Furthermore, almost 58% of all cases traced to a single clinical cause can be attributed to inguinal pathologies alone. Long-standing groin syndrome in the female population shows only one pathological cause with inguinal pathologies, and acetabular labrum tear representing the most frequent etiologies. CONCLUSIONS Men and women exhibit different causes for long-standing groin pain syndrome. Several routine tests used in the clinical evaluation of this condition furnish a low likelihood ratio. Consequently, in order to optimize clinical evaluation and minimize patient discomfort, clinical evaluation should be based on tests with a greater likelihood ratio.
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Affiliation(s)
- Gian N Bisciotti
- Paris Saint Germain FC, Paris, France - .,Kinemove Rehabilitations Center, Pontremoli, Massa-Carrara, Italy -
| | - Alessio Auci
- AUSL Toscana Nord-Ovest, Massa, Massa-Carrara, Italy
| | | | | | - Andrea Bisciotti
- Kinemove Rehabilitations Center, Pontremoli, Massa-Carrara, Italy
| | | | | | | | | | | | - Federica Parra
- Kinemove Rehabilitations Center, Pontremoli, Massa-Carrara, Italy
| | - Raul Zini
- University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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9
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Classifying radiographic changes of the pubic symphysis in male athletes: Development and reproducibility of a new scoring protocol. Eur J Radiol 2020; 134:109452. [PMID: 33310551 DOI: 10.1016/j.ejrad.2020.109452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/08/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To develop a specified radiographic scoring system for the pubic symphysis and adjacent bones, and to examine the intra- and inter-rater reproducibility of this system. METHOD Development of the scoring protocol was performed in three stages using AP pelvis radiographs of 102 male adult athletes. The final protocol included 5 overall scoring items, which included further specification of locations: 1) bone lucency (erosion-like configuration and cysts), 2) proliferation, 3) fragmentation, 4) sclerosis, and 5) joint space width. Intra- and inter-rater reproducibility were determined using Cohen's kappa statistic (κ) and intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and minimal detectable difference (MDD) were also determined. RESULTS We present a radiographic scoring protocol with clear definitions and examples to improve clinical usability. Intra-rater reproducibility was: bone lucency (erosion-like configuration or cysts): κ = 0.67 (95 %CI 0.56-0.78), proliferation: κ = 0.54 (95 %CI 0.38-0.70), fragmentation: κ = 0.80 (95 %CI 0.67-0.93), sclerosis: κ = 0.60 (95 %CI 0.49-0.71), and joint space width: ICC(2.1) 0.85 (95 %CI 0.78-0.89), SEM 0.4 mm, MDD 1.2 mm. Inter-rater reproducibility was: bone lucency: κ = 0.61 (95 %CI 0.50-0.72), proliferation: κ = 0.34 (95 %CI 0.20-0.48), fragmentation: κ = 0.67 (95 %CI 0.50-0.84), sclerosis: κ = 0.30 (95 %CI 0.17-0.43), and joint space width: ICC(2.1) 0.72 (95 %CI 0.59-0.81), SEM 0.5 mm., MDD 1.5 mm. CONCLUSIONS The Aspetar pubic symphysis radiographic scoring protocol contains five overall scoring items, with additional specifications. These five items showed moderate to almost perfect intra-rater reproducibility, and fair to substantial inter-rater reproducibility. This protocol provides the basis for use in clinical practice, and will allow future investigations of the clinical significance of radiographic changes at the pubic symphysis in athletes.
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10
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Bastia P, Ghirarduzzi P, Schiavi P, Donelli D, Pedrazzini A, Leigheb M, Ceccarelli F, Pogliacomi F. Surgical or conservative treatment in ARGP syndrome? A systematic review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:14-24. [PMID: 31821279 PMCID: PMC7233710 DOI: 10.23750/abm.v90i12-s.8962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 12/04/2022]
Abstract
Background and aim of the work: The rectus-adductor syndrome is a common cause of groin pain. In literature the adductor longus is reported as the most frequent site of injury so that the syndrome can be fitted into the adductor related groin pain (ARGP) group. The aim of this study was to define what is the best treatment between surgical and conservative in athletes affected by ARGP in terms of healing and return to play (RTP) time. Methods: A systematic review was performed searching for articles describing studies on RTP time for surgical or conservative interventions for ARGP. A qualitative synthesis was performed. Only 10 out 7607 articles were included in this systematic review. An exploratory meta-analysis was carried out. Due to high heterogeneity of the included studies, raw means of surgery and conservative treatment groups were pooled separately. A random effects model was used. Results: The results showed quicker RTP time for surgery when pooled raw means were compared to conservative treatments: 11,23 weeks (CI 95%, 8.18,14.28, p<0.0001, I^2=99%) vs 14,9 weeks (CI 95%, 13.05,16.76, p<0.0001, I^2 = 77%). The pooled results showed high statistical heterogeneity (I^2), especially in the surgical group. Conclusions: Surgical interventions are associated with quicker RTP time in athletes affected by ARGP, but due to the high heterogeneity of the available studies and the lack of dedicated RCTs this topic needs to be investigated with dedicated high quality RCT studies. (www.actabiomedica.it)
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Affiliation(s)
- Paolo Bastia
- Orthopaedics and Traumatologic Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy .
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11
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Paajanen H, Hermunen H, Ristolainen L, Branci S. Long-standing groin pain in contact sports: a prospective case-control and MRI study. BMJ Open Sport Exerc Med 2019; 5:e000507. [PMID: 31191965 PMCID: PMC6539155 DOI: 10.1136/bmjsem-2018-000507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2019] [Indexed: 12/24/2022] Open
Abstract
Objectives We aimed to prospectively evaluate the prevalence of long-standing groin pain and related MRI findings in contact sports. Methods This case–control study followed three male elite-level soccer, ice-hockey and bandy teams (102 players) for 2 years. All athletes with long-standing groin pain lasting >30 days and age-matched controls (1:3) from the same teams were examined clinically, using pelvic MRI and Hip and Groin Outcome Scores (HAGOS). Primary outcome measures were annual prevalence of groin pain and underlying MRI findings. Results The annual prevalence of chronic groin pain was 7.5%. Training characteristics and pain scores of athletes were similar in all teams. On MRI, there was no significant difference in the percentage of pubic bone marrow oedema (p = 0.80) between symptomatic players (8/15; 53%) versus controls (20/43; 47%), but adductor tendinopathy and degenerative changes at the pubic symphysis were twice more common among players with pain. Rectus muscle or iliopsoas pathology were seldom observed. Lower HAGOS subscales (p < 0.01) were recorded in players who experienced groin pain compared with the controls. Conclusion Long-standing groin pain was observed annually in 1 of 14 athletes in contact sports. Abnormalities in the pubic symphysis were common MRI findings in both symptomatic and asymptomatic players. Trial registration number NCT02560480
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Affiliation(s)
- Hannu Paajanen
- Department of Surgery, University of Eastern Finland, Kuopio, Finland
| | - Heikki Hermunen
- Department of Radiology, Mikkeli Central Hospital, Mikkeli, Finland
| | - Leena Ristolainen
- Department of Orthopaedics, Orton Orthopaedic Hospital, Helsinki, Finland
| | - Sonia Branci
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark.,Arthroscopic Center Amager, Hvidovre Hospital, Copenhagen, Denmark
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Heiss R, Guermazi A, Jarraya M, Engebretsen L, Roemer FW. The epidemiology of MRI-detected pelvic injuries in athletes in the Rio de Janeiro 2016 Summer Olympics. Eur J Radiol 2018; 105:56-64. [PMID: 30017299 DOI: 10.1016/j.ejrad.2018.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To describe the prevalence, severity and location of pelvic injuries, including hip, muscle and tendon pathologies, as assessed on MRI in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games. METHODS We analyzed all pelvic MRIs that were acquired for suspected injury as reported by the National Olympic Committee (NOC) medical teams and the Organizing Committee medical staff during the Rio 2016 Summer Olympics. Diagnostic imaging was performed through the Olympic Village Polyclinic, using 3 T and 1.5 T MR scanners. Images were interpreted retrospectively according to standardized criteria. RESULTS A total of 11,274 athletes participated in the Games, of which 40 (0,4%) were referred for a pelvic MRI. Thirty-seven of the 40 (92%) had at least one abnormal finding, and some had as many as 17, for an average of 4.1 pathologies per examination. Almost half of all abnormal findings were assessed as pre-existing (46%). The majority of acute/subacute injuries were observed in track and field athletes (44%), whereas the highest number of pre-existing findings was seen in ball-sports athletes (39%). Forty-seven per cent of all acute/subacute injuries were muscle injuries with the gluteus maximus muscle the most commonly affected. In contrast, most pre-existing findings were detected at the symphysis (59%). CONCLUSION Our study demonstrated a high prevalence of both acute/subacute injuries and chronic changes in Olympic athletes undergoing pelvic MRI. Muscle injuries were the most common acute injuries, found mainly in track and field athletes. Most chronic changes were identified at the symphysis region in ball-sports athletes.
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Affiliation(s)
- Rafael Heiss
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 3, 91054 Erlangen, Germany.
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, Boston, MA 02118, USA
| | - Mohamed Jarraya
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, Boston, MA 02118, USA; Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19428, USA
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Route de Vidy 11, 1007 Lausanne, Switzerland; Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Sognsveien 220, 0863 Oslo, Norway; Department of Orthopedic Surgery, Oslo University Hospital, University of Oslo, Sognsvannsveien 20, 0372 Osla, Norway
| | - Frank W Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 3, 91054 Erlangen, Germany; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, Boston, MA 02118, USA
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Bou Antoun M, Reboul G, Ronot M, Crombe A, Poussange N, Pesquer L. Imaging of inguinal-related groin pain in athletes. Br J Radiol 2018; 91:20170856. [PMID: 29947268 DOI: 10.1259/bjr.20170856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Inguinal canal-related groin pain is common in athletes and may involve numerous structures such as the conjoint tendon and the transversalis fascia. Ultrasound is the only dynamic tool that shows the passage of preperitoneal fat at the level of the Hesselbach triangle and allows excluding true inguinal hernias. Fascia transversalis bulging and inguinal ring dilatation may also be described. MRI assesses injuries of rectus abdominis and adductor longus enthesis and osteitis symphysis but its accuracy for the diagnosis of inguinal-related groin pain remains debated.
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Affiliation(s)
- Myriame Bou Antoun
- 1 Department of radiology, HEGP hospital, Assistance publique-hôpitaux de paris (AP-HP), University Paris Descartes , Paris , France
| | - Gilles Reboul
- 2 Hernia center, Clinique du sport, Bordeaux-Mérignac , Mérignac , France
| | - Maxime Ronot
- 3 Department of radiology, Beaujon hospital, Assistance publique- hôpitaux de Paris (AP-HP), University of Paris VII , Paris , France
| | - Amandine Crombe
- 4 MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac , Merignac , France
| | - Nicolas Poussange
- 4 MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac , Merignac , France
| | - Lionel Pesquer
- 4 MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac , Merignac , France
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Ducouret E, Reboul G, Dalmay F, Iosif C, Mounayer C, Pesquer L, Dallaudiere B. MRI in chronic groin pain: sequence diagnostic reliability compared to systematic surgical assessment. Skeletal Radiol 2018; 47:649-660. [PMID: 29170813 DOI: 10.1007/s00256-017-2824-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the diagnostic reliability of magnetic resonance imaging (MRI) sequences in chronic groin pain (CGP) compared to surgery and try to propose a suitable MRI protocol. MATERIALS AND METHODS Forty-three consecutive patients with resistant clinical CGP underwent a pre-surgical pelvis MRI. Eight MRI sequences were acquired: axial fast spin-echo T1-weighted (FSE T1), coronal FSE T1, axial-oblique (in symphysis plane) proton density weighted with fat saturation (PDFS), coronal PDFS, sagittal PDFS, axial FSE T1 with fat saturation and gadolinium enhancement (FSGE), coronal FSE T1 FSGE and axial FSE T1 with Valsalva maneuver (VM). These sequences were reviewed for pubic symphysis assessment, adductor longus (AL) tendon and abdominal wall (AW) injuries. The same surgeon operated on all of these patients (26 AL and 49 AW). Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative prospective value (NPV) and accuracy of each sequence and combinations for AL or AW injuries were calculated in comparison to surgical findings. RESULTS One hundred ninety-two sequences were obtained. Coronal T1 FSGE and axial T1 VM proved to be the most reliable sequences (accuracy: 91.67% in AL and 83.33% in AW). The best sequence combination was coronal T1, axial PDFS, sagittal PDFS and axial T1 VM (accuracy: 77.78%; Se: 100.00%, Sp: 69.23%, PPV: 55.56%, NPV: 100.00%). CONCLUSION MRI has 77.78% accuracy, 100.00% sensitivity, 69.23% specificity, 55.56% PPV and 100.00% NPV in evaluating CGP, with coronal T1-axial PDFS-sagittal PDFS-axial T1 VM as the optimal protocol in terms of diagnostic performance within a reasonable scan time. Diagnostic performance of MRI was examined in the evaluation of CGP using surgery as reference standard.
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Affiliation(s)
- Emmanuel Ducouret
- Département de Radiologie, Centre Hospitalier Universitaire Dupuytren, 2 Avenue Martin Luther King, 87042, Limoges, France.
| | - Gilles Reboul
- Service de Chirurgie Pariétale, Clinique du Sport de Bordeaux-Mérignac, 2 rue Georges Négrevergne, 33700, Mérignac, France
| | - François Dalmay
- CEBIMER, Centre Hospitalier Universitaire Dupuytren, 2 Avenue Martin Luther King, 87042, Limoges, France
| | - Christina Iosif
- CHU Jean Minjoz, Besançon, France.,BioEM, CNRS, UMR 7252, Université de Limoges, Limoges, France
| | - Charbel Mounayer
- Département de Neuroradiologie Interventionnelle, Centre Hospitalier Universitaire Dupuytren, 2 Avenue Martin Luther King, 87042, Limoges, France
| | - Lionel Pesquer
- Centre d'imagerie ostéoarticulaire, Clinique du Sport, Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700, Mérignac, France
| | - Benjamin Dallaudiere
- Centre d'imagerie ostéoarticulaire, Clinique du Sport, Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700, Mérignac, France.,Service de Radiologie, Département d'imagerie Musculo-Squelettique, Centre Hospitalier Universitaire Pellegrin, place Amélie-Léon-Rabat, 33000, Bordeaux, France.,Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536, CNRS, Université de Bordeaux, 146 rue Léo Saignat, 33076, Bordeaux, France
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Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management. J Orthop Sports Phys Ther 2018; 48:239-249. [PMID: 29510653 DOI: 10.2519/jospt.2018.7850] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis Groin pain is common in athletes who participate in multidirectional sports and has traditionally been considered a difficult problem to understand, diagnose, and manage. This may be due to sparse historical focus on this complex region in sports medicine. Until recently, there has been little agreement regarding terminology, definitions, and classification of groin pain in athletes. This has made clear communication between clinicians difficult, and the results of research difficult to interpret and implement into practice. However, during the past decade, the field has evolved rapidly, and an evidence-based understanding is now emerging. This clinical commentary discusses the clinical examination (subjective history, screening, physical examination); imaging; testing of impairments, function, and performance; and management of athletes with groin pain in an evidence-based framework. J Orthop Sports Phys Ther 2018;48(4):239-249. Epub 6 Mar 2018. doi:10.2519/jospt.2018.7850.
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Thorborg K, Branci S, Nielsen MP, Langelund MT, Hölmich P. Copenhagen five-second squeeze: a valid indicator of sports-related hip and groin function. Br J Sports Med 2016; 51:594-599. [DOI: 10.1136/bjsports-2016-096675] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 11/04/2022]
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Serner A, Roemer FW, Hölmich P, Thorborg K, Niu J, Weir A, Tol JL, Guermazi A. Reliability of MRI assessment of acute musculotendinous groin injuries in athletes. Eur Radiol 2016; 27:1486-1495. [DOI: 10.1007/s00330-016-4487-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 12/27/2022]
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de SA D, Hölmich P, Phillips M, Heaven S, Simunovic N, Philippon MJ, Ayeni OR. Athletic groin pain: a systematic review of surgical diagnoses, investigations and treatment. Br J Sports Med 2016; 50:1181-6. [DOI: 10.1136/bjsports-2015-095137] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 01/29/2023]
Abstract
IntroductionAthletic groin pain requiring surgery remains a diagnostic and therapeutic challenge. This systematic review aims to identify the most common causes of groin pain in athletes requiring surgery. Additionally, it aims to further characterise their susceptible athlete profiles, common physical examination and imaging techniques, and surgical procedures performed. This will enable the orthopaedic sports medicine clinician/surgeon to best treat these patients.Materials and methodsThe electronic databases MEDLINE, PubMed and EMBASE were searched from database inception to 13 August 2014 for studies in the English language that addressed athletic groin pain necessitating surgery. The search was updated on 4 August 2015 to find any articles published after the original search. The studies were systematically screened and data were abstracted in duplicate, with descriptive data presented.ResultsA total of 73 articles were included within our study, with data from 4655 patients abstracted. Overall, intra-articular and extra-articular causes of groin pain in athletes requiring surgery were equal. The top five causes for pain were: femoroacetabular impingement (FAI) (32%), athletic pubalgia (24%), adductor-related pathology (12%), inguinal pathology (10%) and labral pathology (5%), with 35% of this labral pathology specifically attributed to FAI.ConclusionsGiven the complex anatomy, equal intra-articular and extra-articular contribution, and potential for overlap of clinical entities causing groin pain leading to surgery in athletes, further studies are required to ascertain the finer details regarding specific exam manoeuvres, imaging views and surgical outcomes to best treat this patient population.
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Thorborg K, Rathleff MS, Petersen P, Branci S, Hölmich P. Prevalence and severity of hip and groin pain in sub-elite male football: a cross-sectional cohort study of 695 players. Scand J Med Sci Sports 2015; 27:107-114. [DOI: 10.1111/sms.12623] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 11/28/2022]
Affiliation(s)
- K. Thorborg
- Sports Orthopedic Research Center - Copenhagen (SORC-C); Arthroscopic Center Hvidovre; Department of Orthopedic Surgery; Copenhagen University Hospital; Amager-Hvidovre Denmark
- Physical Medicine Rehabilitation Research - Copenhagen (PMR-C); Copenhagen University Hospital; Amager-Hvidovre Denmark
| | - M. S. Rathleff
- Center for Sensory-Motor Interaction (SMI); Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg Denmark
| | - P. Petersen
- Sports Orthopedic Research Center - Copenhagen (SORC-C); Arthroscopic Center Hvidovre; Department of Orthopedic Surgery; Copenhagen University Hospital; Amager-Hvidovre Denmark
| | - S. Branci
- Sports Orthopedic Research Center - Copenhagen (SORC-C); Arthroscopic Center Hvidovre; Department of Orthopedic Surgery; Copenhagen University Hospital; Amager-Hvidovre Denmark
- Department of Radiology, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - P. Hölmich
- Sports Orthopedic Research Center - Copenhagen (SORC-C); Arthroscopic Center Hvidovre; Department of Orthopedic Surgery; Copenhagen University Hospital; Amager-Hvidovre Denmark
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Serner A, Tol JL, Jomaah N, Weir A, Whiteley R, Thorborg K, Robinson M, Hölmich P. Diagnosis of Acute Groin Injuries: A Prospective Study of 110 Athletes. Am J Sports Med 2015; 43:1857-64. [PMID: 25977522 DOI: 10.1177/0363546515585123] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute groin injuries are common in high-intensity sports, but there are insufficient data on injury characteristics such as injury mechanisms and clinical and radiological findings. PURPOSE To describe these characteristics in a cohort of athletes. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 110 male athletes (mean age, 25.6 ± 4.7 years) with sports-related acute groin pain were prospectively included within 7 days of injury from August 2012 to April 2014. Standardized history taking, a clinical examination, magnetic resonance imaging (MRI), and/or ultrasound (US) were performed. RESULTS The most frequent injury mechanism in soccer was kicking (40%), and change of direction was most frequent in other sports (31%). Clinically, adductor injuries accounted for 66% of all injuries and primarily involved the adductor longus on imaging (91% US, 93% MRI). The iliopsoas and proximal rectus femoris were also frequently injured according to all examination modalities (15%-25%). Acute injury findings were negative in 22% of the MRI and 25% of the US examinations. Of the clinically diagnosed adductor injuries, 3% (US) and 6% (MRI) showed a radiological injury in a different location compared with 35% to 46% for clinically diagnosed iliopsoas and proximal rectus femoris injuries. CONCLUSION Adductor injuries account for the majority of acute groin injuries. Iliopsoas and proximal rectus femoris injuries are also common. More than 1 in 5 injuries showed no imaging signs of an acute injury. Clinically diagnosed adductor injuries were often confirmed on imaging, whereas iliopsoas and rectus femoris injuries showed a different radiological injury location in more than one-third of the cases. The discrepancy between clinical and radiological findings should be considered when diagnosing acute groin injuries.
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Affiliation(s)
- Andreas Serner
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Nabil Jomaah
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Adam Weir
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Rodney Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | | | - Per Hölmich
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
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