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>Imaging Assessment of the Pubis in Soccer Players[*]Article in several languages: português | English
21 August 2017
21 December 2017
10 May 2019 (online)
Objective To compare the accuracy of ultrasound (US) with that of magnetic resonance imaging (MRI) in the detection of aponeurosis lesions of the rectus abdominis/adductor longus muscles, to study the characteristics of the athletes and imaging findings associated with pubalgia, and to demonstrate the importance of each method in evaluating this condition.
Materials and methods The present study was conducted from 2011 to 2016 with 39 professional soccer players: 15 with pubalgia and 24 without pubalgia. Age, field position, body mass index (BMI), weekly training load, career length, and history of thigh/knee injury and lower back pain were recorded. The following tests were performed: radiographs (anteroposterior view of the pelvis in standing and ﬂamingo positions) to evaluate hip impingement, sacroiliac joint, and pubic symphysis instability; US to analyze the common aponeurosis of the rectus abdominis/adductor longus muscles and inguinal hernias; and MRI for pubic bone degenerative alterations and edema, and lesions in the adductor and rectus abdominis muscles and their aponeurosis.
Results There was an association between pubalgia, high BMI (p = 0.032) and muscle alterations (p < 0.001). Two patients with pubalgia had inguinal hernias and one patient with pubalgia and two controls had sports hernias. Pubic degenerative changes were frequent in both groups. Aponeurosis lesions were more frequent in patients with pain. The US detection had 44.4% sensitivity and 100% speciﬁcity.
Conclusion The evaluation of athletic pubalgia should be performed with radiography, US, and MRI. High BMI, muscle injuries, geodes, and osteophytes are ﬁndings associated with pubalgia; US has low sensitivity to detect injuries of the common aponeurosis of the rectus abdominis/adductor longus muscles.
Keywordsmagnetic resonance imaging/methods - pubic symphysis/diagnostic imaging - pubic symphysis/injuries - groin - radiography - athletic injuries/pathology - ultrasonography
* Work developed at the Hospital Santa Monica, Erechim, RS, Brazil and at the Instituto de Ortopedia e Traumatologia of the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
- 1 Kavanagh EC, Koulouris G, Ford S, McMahon P, Johnson C, Eustace SJ. MR imaging of groin pain in the athlete. Semin Musculoskelet Radiol 2006; 10 (03) 197-207
- 2 Omar IM, Zoga AC, Kavanagh EC, Koulouris G, Bergin D, Gopez AG. , et al. Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics 2008; 28 (05) 1415-1438
- 3 Paajanen H, Ristolainen L, Turunen H, Kujala UM. Prevalence and etiological factors of sport-related groin injuries in top-level soccer compared to non-contact sports. Arch Orthop Trauma Surg 2011; 131 (02) 261-266
- 4 Harris NH, Murray RO. Lesions of the symphysis in athletes. BMJ 1974; 4 (5938): 211-214
- 5 Overdeck KH, Palmer WE. Imaging of hip and groin injuries in athletes. Semin Musculoskelet Radiol 2004; 8 (01) 41-55
- 6 Davies AG, Clarke AW, Gilmore J, Wotherspoon M, Connell DA. Review: imaging of groin pain in the athlete. Skeletal Radiol 2010; 39 (07) 629-644
- 7 Mullens FE, Zoga AC, Morrison WB, Meyers WC. Review of MRI technique and imaging findings in athletic pubalgia and the “sports hernia”. Eur J Radiol 2012; 81 (12) 3780-3792
- 8 Zoga AC, Mullens FE, Meyers WC. The spectrum of MR imaging in athletic pubalgia. Radiol Clin North Am 2010; 48 (06) 1179-1197
- 9 Brennan D, O'Connell MJ, Ryan M, Cunningham P, Taylor D, Cronin C. , et al. Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology 2005; 235 (01) 162-167
- 10 Cunningham PM, Brennan D, O'Connell M, MacMahon P, O'Neill P, Eustace S. Patterns of bone and soft-tissue injury at the symphysis pubis in soccer players: observations at MRI. AJR Am J Roentgenol 2007; 188 (03) W291-W296
- 11 Paajanen H, Hermunen H, Karonen J. Effect of heavy training in contact sports on MRI findings in the pubic region of asymptomatic competitive athletes compared with non-athlete controls. Skeletal Radiol 2011; 40 (01) 89-94
- 12 Robinson P, Barron DA, Parsons W, Grainger AJ, Schilders EM, O'Connor PJ. Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings. Skeletal Radiol 2004; 33 (08) 451-457
- 13 Robinson P, Bhat V, English B. Imaging in the assessment and management of athletic pubalgia. Semin Musculoskelet Radiol 2011; 15 (01) 14-26
- 14 Silvis ML, Mosher TJ, Smetana BS, Chinchilli VM, Flemming DJ, Walker EA. , et al. High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med 2011; 39 (04) 715-721
- 15 Slavotinek JP, Verrall GM, Fon GT, Sage MR. Groin pain in footballers: the association between preseason clinical and pubic bone magnetic resonance imaging findings and athlete outcome. Am J Sports Med 2005; 33 (06) 894-899
- 16 Verrall GM, Slavotinek JP, Barnes PG, Fon GT, Spriggins AJ. Clinical risk factors for hamstring muscle strain injury: a prospective study with correlation of injury by magnetic resonance imaging. Br J Sports Med 2001; 35 (06) 435-439 , discussion 440
- 17 Balconi G. US in pubalgia. J Ultrasound 2011; 14 (03) 157-166
- 18 Orchard JW, Read JW, Neophyton J, Garlick D. Groin pain associated with ultrasound finding of inguinal canal posterior wall deficiency in Australian Rules footballers. Br J Sports Med 1998; 32 (02) 134-139
- 19 Morley N, Grant T, Blount K, Omar I. Sonographic evaluation of athletic pubalgia. Skeletal Radiol 2016; 45 (05) 689-699
- 20 Kachingwe AF, Grech S. Proposed algorithm for the management of athletes with athletic pubalgia (sports hernia): a case series. J Orthop Sports Phys Ther 2008; 38 (12) 768-781
- 21 Garras DN, Carothers JT, Olson SA. Single-leg-stance (flamingo) radiographs to assess pelvic instability: how much motion is normal?. J Bone Joint Surg Am 2008; 90 (10) 2114-2118
- 22 Rodriguez C, Miguel A, Lima H, Heinrichs K. Osteitis pubis syndrome in the professional soccer athlete: a case report. J Athl Train 2001; 36 (04) 437-440
- 23 Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R. Intrinsic risk factors for groin injuries among male soccer players: a prospective cohort study. Am J Sports Med 2010; 38 (10) 2051-2057
- 24 Garvey JF, Read JW, Turner A. Sportsman hernia: what can we do?. Hernia 2010; 14 (01) 17-25
- 25 Voos JE, Mauro CS, Kelly BT. Femoroacetabular impingement in the athlete: compensatory injury patterns. Oper Tech Orthop 2010; 20: 231-236
- 26 Ekstrand J, Hägglund M, Waldén M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 2011; 39 (06) 1226-1232
- 27 Werner J, Hägglund M, Waldén M, Ekstrand J. UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 2009; 43 (13) 1036-1040
- 28 Gullmo A. Herniography. The diagnosis of hernia in the groin and incompetence of the pouch of Douglas and pelvic floor. Acta Radiol Suppl 1980; 361: 1-76
- 29 Yilmazlar T, Kizil A, Zorluoglu A, Ozgüç H. The value of herniography in football players with obscure groin pain. Acta Chir Belg 1996; 96 (03) 115-118
- 30 Gilmore O. Gilmore's groin: ten years experience of groin disruption–a previously unsolved problem in sportsmen. Sports Med Soft Tissue Trauma. 1991; 1 (01) 12-14