The prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement

Varada, Sowmya; Moy, Matthew P.; Wu, Fangbai; Rasiej, Michael J.; Jaramillo, Diego; Wong, Tony T.

doi:10.1007/s00256-020-03405-z

Cited by 12 publications

(14 citation statements)

References 28 publications

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“…Furthermore, Saito et al 25 reported that alpha angle was significantly larger among patients with pubic BME as compared with those with no BME. Varada et al 29 evaluated patients with FAI and found that male sex, history of sports participation, and morphology of the femoral cam with an alpha angle ≥60° were significant predictors of damage patterns of athletic pubalgia on MRI scans. Notably, in our study, we did not observe SCS in patients with an LCE angle <22°, and we determined that SCS was more frequent in patients having cam impingement and excess acetabular coverage of the socket.…”

Section: Discussionmentioning

confidence: 99%

Cleft Sign and Bone Marrow Edema of the Pubic Symphysis Are Associated With Sports and Bony Morphology in Patients With Femoroacetabular Impingement and Labral Tears

Nakayama

Utsunomiya

Murata

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: The cleft sign (CS) and bone marrow edema (BME) are considered magnetic resonance imaging (MRI) findings signifying a pubic pathology, which is associated with groin pain; however, their relationship with bony morphology related to femoroacetabular impingement (FAI) has not been established. Purpose: To investigate the prevalence of CS and BME in symptomatic patients with acetabular labral tears and assess their possible association with bone morphology and sport-specific activities. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study enrolled 418 patients (469 hips) undergoing hip arthroscopic surgery for labral tears. Also included were patients with labral tears in the setting of either hip dysplasia or borderline hip dysplasia who were undergoing endoscopic shelf acetabuloplasty combined with hip arthroscopic labral repair, cam osteoplasty, and capsular plication. All patients were screened for superior CS (SCS), inferior CS (ICS), and BME of the ipsilateral side of the pubis using 3-T MRI. We measured the following angles: lateral center edge (LCE), Sharp, Tönnis, vertical-central-anterior, and alpha. Then, we evaluated the relationship between patient characteristics and abnormal findings on MRI scans (preoperatively vs 1 year postoperatively). Results: An overall 397 hips were included: 200 in men and 197 in women (mean ± SD age, 35.3 ± 16.0 years). There were hips in 214 athletes (53.9%) and hips in 183 nonathletes (46.1%). MRI findings revealed SCS, ICS, and BME in 18 (4.5%), 13 (3.3%), and 34 hips (8.6%), respectively. Abnormal MRI findings at the pubis were seen more often in athletes than nonathletes (23.8% vs 3.3%), and contact sports athletes had the most frequent abnormalities. There was no SCS in patients with an LCE angle <22°. SCS was more frequently seen in those who had an alpha angle ≥71°. More than 60% of abnormal findings at the pubis diminished after arthroscopic surgery that included FAI correction and labral repair. Conclusion: In patients with labral tears, CS and BME were seen more frequently in athletes versus nonathletes, especially contact athletes with FAI-related bony abnormalities. More than 60% of abnormal MRI pubis findings resolved after arthroscopic treatment of FAI.

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Section: Discussionmentioning

confidence: 99%

Cleft Sign and Bone Marrow Edema of the Pubic Symphysis Are Associated With Sports and Bony Morphology in Patients With Femoroacetabular Impingement and Labral Tears

Nakayama

Utsunomiya

Murata

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…However, this signal change is thought to occur before the onset of symptoms [ 34 ] and may also progress asymptomatically [ 19 , 35 ]. Since many studies of the association between FAIS and osteitis pubis have considered MRI findings, including those of asymptomatic cases, superior in identifying osteitis pubis [ 6 , 8–10 , 36 ], we also used pubic BME on MRI to assess osteitis pubis in this study. We believe that this does not weaken the conclusions of the present study.…”

Section: Discussionmentioning

confidence: 99%

The prevalence and risk factors of pubic bone marrow edema in femoroacetabular impingement and hip dysplasia

Shimodaira

Hatakeyama

Suzuki

et al. 2021

Journal of Hip Preservation Surgery

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Femoroacetabular impingement syndrome (FAIS) has been associated with osteitis pubis; however, it is still unclear whether hip dysplasia is associated with osteitis pubis. This study aimed to investigate (i) the incidence of pubic bone marrow edema (BME) on magnetic resonance imaging in symptomatic patients with FAIS, borderline developmental dysplasia of the hip (BDDH) and developmental dysplasia of the hip (DDH) undergoing hip arthroscopic surgery with labral preservation and (ii) the demographic and radiographic factors associated with pubic BME. A total of 259 symptomatic patients undergoing hip arthroscopic surgery between July 2016 and April 2019 were retrospectively reviewed and divided into three groups: FAIS (180 patients), BDDH (29 patients) and DDH (50 patients). Diffuse changes in the pubic bone adjacent to the pubic symphysis were labeled pubic BME, and the prevalence of their occurrence was examined. Multivariate logistic regression analysis was performed to identify factors involved in pubic BME, and odds ratios (ORs) for relevant factors were calculated. There was no significant difference in the prevalence of pubic BME among the three groups (20 [11.1%] of 180 FAIS patients, 6 [20.6%] of 29 BDDH patients and 7 [14%] of 50 DDH patients, P = 0.325). Multivariate logistic regression analysis showed that acetabular coverage was not associated with pubic BME, whereas younger age and greater alpha angle were still independent associated factors [age ≤26 years (OR, 65.7) and alpha angle ≥73.5° (OR, 4.79)]. Determining the possible association of osteitis pubis with cam impingement in dysplastic hips may provide insights toward a more accurate understanding of its pathophysiology.

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“…5 MRI with coronal T1, axial and sagittal PDFS sequences is 100% sensitive and 69.2% specific in the evaluation of chronic groin pain when compared with findings at the time of surgery. 6 In a study by Varada et al, 14 MRI findings consistent with CMI were more prevalent in patients with underlying FAI, compared with control subjects. Patients with FAI and an alpha angle >60 had a markedly higher number of aponeurotic plate tears, again emphasizing the overlap between CMI and FAI.…”

Section: Screening/examination and Imagingmentioning

confidence: 92%

Core Muscle Injury Producing Groin Pain in the Athlete: Diagnosis and Treatment

Mullen

Hadley

Vopat

et al. 2023

J Am Acad Orthop Surg

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Groin pain is a common cause of pain in the athlete and may be the result of a variety of causes. Musculoskeletal groin injuries are often associated with muscle strain, particularly the adductor and abdominal muscles, termed "core muscle injury" (CMI). Since the early 1960s, there have been a growing number of articles intending to identify, define, prevent, and treat this condition; to date, however, the lack of a universal definition and treatment approach has complicated the narrative around CMI. This article intends to review the recent literature surrounding CMI, identifying common defining characteristics, as well as delineating treatment protocols that benefit the injured patient populations. Emphasis is placed on the clinical outcomes of different treatment methodologies and failure rates.

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The prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement

Cited by 12 publications

References 28 publications

Cleft Sign and Bone Marrow Edema of the Pubic Symphysis Are Associated With Sports and Bony Morphology in Patients With Femoroacetabular Impingement and Labral Tears

Cleft Sign and Bone Marrow Edema of the Pubic Symphysis Are Associated With Sports and Bony Morphology in Patients With Femoroacetabular Impingement and Labral Tears

The prevalence and risk factors of pubic bone marrow edema in femoroacetabular impingement and hip dysplasia

Core Muscle Injury Producing Groin Pain in the Athlete: Diagnosis and Treatment

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