High insertion of conjoint tendon is associated with inguinal-related groin pain: a MRI study
To compare the insertions of the conjoint tendon (CT) on MRI in athletes with and without symptoms and to assess their relationship to groin pain with surgery as a reference.
Materials and methods
Between January and May 2017, patients with inguinal-related groin pain undergoing Shouldice repair were prospectively enrolled and underwent MRI. Exams were independently reviewed by two radiologists blinded to surgical results to assess types of CT insertion as high muscular without (type 1) or with tendinous expansion (type 2) or low muscular (type 3). Radiological and surgical results were compared. Patients were compared with a gender- and age-matched control group of asymptomatic athletes.
One hundred twenty-eight walls (64 in patients, 64 in controls) in 64 subjects (32 patients and 32 controls, only men; mean age, 31.7 ± 10 years; range, 15.0–54.8) were analyzed. CT insertion was defined as types 1, 2, and 3 in 32/128 (25%), 35/128 (27%), and 61/128 (48%) walls, respectively, with 22/64 (34%), 27/64 (42%), and 15/64 (23%) in patients and 10/64 (16%), 8/64 (12.5%), and 46/64 (72%) in controls. Type s1+2 were significantly more frequent in patients compared with that in controls (p < 0.01). MRI predicted a high CT insertion with a sensitivity and specificity of 97% (95%CI 85–99) and 62% (95%CI 36–82). The intra- and inter-reader agreement for the prediction of the type of insertion was excellent (k > 0.75).
A high CT insertion is more frequent in athletes with groin pain and may be a predisposing factor. MRI could help predict the type of CT insertion.
• MR imaging should be included in the initial workup of patients with inguinal-related groin pain.
• MR imaging can be used to visualize the type of insertion with acceptable results.
• High insertion of the conjoint tendon may be a predisposing factor for inguinal-related groin pain.
KeywordsHip Tendons Inguinal canal Groin Abdominal wall
Body mass index
- MR imaging
Magnetic resonance imaging
Negative predictive value
Positive predictive value
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Lionel Pesquer.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
Maxime Ronot kindly provided statistical advice for this manuscript.
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• case-control study
• performed at one institution
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