Semin Musculoskelet Radiol 2020; 24(S 02): S9-S32
DOI: 10.1055/s-0040-1722512
Poster Presentations

Superior and Secondary Cleft Signs in Athletic Groin Pain: Correlation of Dedicated MRI and Symphysography Findings as Well as Anterior Pelvic Ring Instability

M. A. Weber
1   Rostock, Germany
,
J. S. Gerhardt
1   Rostock, Germany
,
T. Tischer
1   Rostock, Germany
,
N. Holl
1   Rostock, Germany
,
R. Lenz
1   Rostock, Germany
,
J. Krüger
2   Berlin, Germany
› Author Affiliations
 

Purpose: The objective of this ongoing study was to correlate patterns of injury such as superior and secondary cleft signs of dedicated magnetic resonance imaging (MRI) with targeted fluoroscopy-guided contrast agent injection into the symphyseal cleft in patients with athletic chronic groin pain. In addition, the presence of symphyseal instability as assessed by flamingo-view projection radiographs was correlated to the presence of a cleft sign.

Methods and Materials: A total of 22 men active in sports (mean age: 36.7 years; 16 soccer players) were included. Other reasons for groin pain were excluded by a senior surgeon with special expertise in athletic groin pain by using a standardized medical history and examination form. Standing single-leg stance (flamingo-view) radiographs were performed in all patients to test for pathologic motion at the pubic symphysis, and a 2-mm vertical shift at the pubic symphysis was considered indicative of anterior pelvic ring instability. The 3-T MRI protocol included axial oblique T1, T2, and fat-saturated T2-weighted turbo spin-echo sequences as well as a sagittal fat-saturated T2-weighted turbo spin-echo sequence with a voxel size of 0.6 × 0.6 × 2.0 mm3 for the T2 and 0.8 × 0.8 × 2.0 mm3 for the T1-weighted sequence, to optimally assess the symphyseal joint and the prepubic aponeurotic complex. Symphyseal cleft injection was performed in aseptic conditions in each patient with fluoroscopic guidance using a 22G needle and injection of 1 mL nonionic contrast material into the primary symphyseal cleft midway between the upper and lower margins of the symphysis. The presence or absence of the superior cleft sign, secondary cleft sign, and osteitis pubis as defined by Byrne et al. (AJR 2017;209:380–388) was recorded.

Results: Mean symptom duration was 8.6 months, and parasymphyseal bone marrow edema reflecting acute osteitis pubis was present in 18 of 22 patients. In 12 patients, bone marrow edema was observed bilaterally. Superior cleft sign was present in 14 and secondary cleft sign in 10 patients. In six patients, both cleft signs were present simultaneously. All cleft signs detected on MRI were also observed in symphysography, except two cases of superior cleft sign. Anterior pelvic ring instability was observed in 11 patients and always linked with a cleft sign observed in MRI, superior in 6 and secondary in 5 patients.

Conclusion: Dedicated 3-T MRI makes an additional symphysography for purely diagnostic purposes unnecessary for AU: Please spell out first names of authors and add academic degrees for each author. Tuberculous empyema necessitates AU: Please spell out first names of authors and add academic degrees for each author.the detection of superior and secondary clefts. The value of symphysography may rather be the therapeutic injection of corticosteroids and local anesthetics. Microtearing at the prepubic aponeurotic complex is a prerequisite for the development of anterior pelvic ring instability.



Publication History

Article published online:
17 December 2020

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