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Athletic Pubalgia and the "Sports Hernia": MR Imaging Findings¹

¹ From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, 10th Floor, Philadelphia, PA 19107 (A.C.Z., E.C.K., W.B.M.); Department of Radiology, Northwestern University Hospital, Chicago, Ill (I.M.O.); Department of Radiology, The Alfred Hospital, Prahran, Victoria, Australia (G.K.); Department of Pathology, Anatomy and Cell Biology, JMC Department of Physical Therapy, Jefferson College of Health Professions, Philadelphia, Pa (H.L.); and Departments of Radiology (A.C., J.D.) and Surgery (W.C.M.), Hahnemann University Hospital, Drexel University College of Medicine, Philadelphia, Pa. Received January 8, 2007; revision requested March 1; final revision received September 6; accepted September 26; final version accepted November 7. Address correspondence to A.C.Z. (e-mail: adam.zoga{at}jefferson.edu).

Purpose: To retrospectively determine the sensitivity and specificity of magnetic resonance (MR) imaging findings in patients with clinical athletic pubalgia, with either surgical or physical examination findings as the reference standard.

Materials and Methods: Institutional review board approval was granted for this HIPAA-compliant study, and informed consent was waived. MR imaging studies in 141 patients (134 male patients, seven female patients; mean age, 30.1 years; range, 17–71 years) who had been referred to a subspecialist because of groin pain were reviewed for findings including hernia, pubic bone marrow edema, secondary cleft sign, and rectus abdominis and adductor tendon injury. MR imaging findings were compared with surgical findings for 102 patients, physical examination findings for all 141 patients, and MR imaging findings in an asymptomatic control group of 25 men (mean age, 29.8 years; range, 18–39 years). Sensitivity and specificity of MR imaging for rectus abdominis and adductor tendon injury were determined by using a ² analysis, and significance of the findings was analyzed with an unpaired Student t test. Disease patterns seen at MR imaging were compared with those reported in the surgical and sports medicine literature.

Results: One hundred thirty-eight (98%) of 141 patients had findings at MR imaging that could cause groin pain. Compared with surgery, MR imaging had a sensitivity and specificity, respectively, of 68% and 100% for rectus abdominis tendon injury and 86% and 89% for adductor tendon injury. Injury in each of these structures was significantly more common in the patient group than in the control group (P < .001). Only two patients had hernias at surgery. At MR imaging, injury or disease could be fit into distinct groups, including osteitis pubis, adductor compartment injury, rectus abdominis tendon injury, and injury or disease remote from the pubic symphysis. Patients with injury involving the rectus abdominis insertion were most likely to go on to surgical pelvic floor repair.

Conclusion: MR imaging depicts patterns of findings in patients with athletic pubalgia, including rectus abdominis insertional injury, thigh adductor injury, and articular diseases at the pubic symphysis (osteitis pubis).

© RSNA, 2008