Skip to main content
SpringerLink
Log in

MR imaging spectrum of adolescent pubic symphyseal injuries/athletic pubalgia

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Magnetic resonance imaging (MRI) findings associated with athletic pubalgia are well documented in the adult literature.

Objective

To describe the spectrum of MRI findings in adolescents with pubic symphyseal injuries/athletic pubalgia.

Materials and methods

This is an institutional review board approved, retrospective study of all patients < 18 years who were referred for MRI, over the last 10 years. Two pediatric musculoskeletal radiologists evaluated the MRI in consensus for the following findings: Chronic Salter-Harris (SH)-I equivalent fracture or asymmetric parasymphyseal ossific fraying, non-retractile muscular tear or retraction, and edema of the aponeurosis and arcuate ligament. Radiographs were also reviewed for Risser stage.

Results

Fifteen patients were identified (100% male, median age 17 years, IQR 16–17.6). Most patients (14/15, 93%) had either asymmetric parasymphyseal ossific fraying (4/15, 27%) or chronic SH-1 equivalent fracture (10/15, 67%) of the pubic symphysis, and all patients (15/15, 100%) had aponeurotic and arcuate ligament edema. Few patients had rectus abdominis muscular retraction (2/15, 13%), non-retractile muscular tear of the rectus abdominis (2/15, 13%), and/or adductor muscle (4/15, 27%). Risser stage was as follows: stages 0 (13%), 3 (7%), 4 (47%), and 5 (33%). The injuries in our limited data set were independent of skeletal maturity with no statistically significant association between any of the MRI findings and Risser stage.

Conclusion

The MR imaging spectrum of adolescent athletic pubalgia differs from the described findings in adults due to skeletal immaturity. The cleft sign described in adults manifests in adolescents as asymmetric parasymphyseal ossific fraying and chronic SH-1 equivalent fractures.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

Data availability

Data will be made available on reasonable request.

References

  1. Brandon CJ, Jacobson JA, Fessell D et al (2011) Groin pain beyond the hip: how anatomy predisposes to injury as visualized by musculoskeletal ultrasound and MRI. AJR Am J Roentgenol 197:1190–1197. https://doi.org/10.2214/AJR.10.4890

    Article  PubMed  Google Scholar 

  2. Koulouris G (2008) Imaging review of groin pain in elite athletes: an anatomic approach to imaging findings. AJR Am J Roentgenol 191:962–972. https://doi.org/10.2214/AJR.07.3410

    Article  PubMed  Google Scholar 

  3. Omar IM, Zoga AC, Kavanagh EC et al (2008) Athletic pubalgia and sports hernia: optimal MR imaging technique and findings. Radiographics 28:1415–1438. https://doi.org/10.1148/rg.285075217

    Article  PubMed  Google Scholar 

  4. Elattar O, Choi HR, Dills VD, Busconi B (2016) Groin injuries (athletic pubalgia) and return to play. Sports Health 8:313–323. https://doi.org/10.1177/1941738116653711

    Article  PubMed  PubMed Central  Google Scholar 

  5. Weir A, Brukner P, Delahunt E et al (2015) Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 49:768–774. https://doi.org/10.1136/bjsports-2015-094869

    Article  PubMed  Google Scholar 

  6. Heijboer WMP, Weir A, Delahunt E et al (2022) A Delphi survey and international e-survey evaluating the Doha agreement meeting classification system in groin pain: where are we 5 years later? J Sci Med Sport 25:3–8. https://doi.org/10.1016/j.jsams.2021.06.014

    Article  PubMed  Google Scholar 

  7. Broadley P, Offiah AC (2014) Hip and groin pain in the child athlete. Semin Musculoskelet Radiol 18:478–488. https://doi.org/10.1055/s-0034-1389265

    Article  PubMed  Google Scholar 

  8. Cunningham PM, Brennan D, O’Connell M, MacMahon P, O’Neill P, Eustace S (2007) Patterns of bone and soft-tissue injury at the symphysis pubis in soccer players: observations at MRI. AJR Am J Roentgenol 188:W291–W296. https://doi.org/10.2214/AJR.06.0051

    Article  PubMed  Google Scholar 

  9. Zoga AC, Kavanagh EC, Omar IM et al (2008) Athletic pubalgia and the sports hernia: MR imaging findings. Radiology 247:797–807. https://doi.org/10.1148/radiol.2473070049

    Article  PubMed  Google Scholar 

  10. Meyers WC, McKechnie A, Philippon MJ, Horner MA, Zoga AC, Devon ON (2008) Experience with sports hernia spanning two decades. Ann Surg 248:656–665. https://doi.org/10.1097/SLA.0b013e318187a770

    Article  PubMed  Google Scholar 

  11. Hynes JP, O’Flaherty M, Glynn D, Eustace S, Kavanagh EC (2023) Imaging of groin pain in athletes: patterns of injury at MRI and gender differences therein. Ir J Med Sci 192:1411–1418. https://doi.org/10.1007/s11845-022-03126-3

    Article  PubMed  Google Scholar 

  12. Branci S, Thorborg K, Bech BH et al (2015) The Copenhagen standardised MRI protocol to assess the pubic symphysis and adductor regions of athletes: outline and intratester and intertester reliability. Br J Sports Med 49:692–699. https://doi.org/10.1136/bjsports-2014-094239

    Article  PubMed  Google Scholar 

  13. Brennan D, O’Connell MJ, Ryan M et al (2005) Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology 235:162–167. https://doi.org/10.1148/radiol.2351040045

    Article  PubMed  Google Scholar 

  14. Baumgart M, Wiśniewski M, Grzonkowska M, Badura M, Szpinda M, Pawlak-Osińska K (2019) Quantitative anatomy of the primary ossification center in the fetal pubis bone. Surg Radiol Anat 41:755–761. https://doi.org/10.1007/s00276-019-02229-4

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sailly M, Whiteley R, Read JW, Giuffre B, Johnson A, Hölmich P (2015) Pubic apophysitis: a previously undescribed clinical entity of groin pain in athletes. Br J Sports Med 49:828–834. https://doi.org/10.1136/bjsports-2014-094436

    Article  PubMed  Google Scholar 

  16. van Ovost A, Hanff DF, Serner A, van Klij P, Agricola R, Weir A (2023) Radiographic assessment of the pubic symphysis in elite male adolescent football players: development and reliability of the Maturing Adolescent Pubic Symphysis (MAPS) classification. Eur J Radiol 167:111068. https://doi.org/10.1016/j.ejrad.2023.111068

    Article  PubMed  Google Scholar 

  17. Koh E, Boyle J (2020) Pubic apophysitis in elite Australian rules football players: MRI findings and the utility of VIBE sequences in evaluating athletes with groin pain. Clin Radiol 75:293–301. https://doi.org/10.1016/j.crad.2019.12.022

    Article  CAS  PubMed  Google Scholar 

  18. So CC, Niakan LS, Garza-Gongora RD (2023) Imaging of the pubic symphysis: anatomy and pathologic conditions. Radiographics 43:e220058. https://doi.org/10.1148/rg.220058

    Article  PubMed  Google Scholar 

  19. O’Dell MC, Jaramillo D, Bancroft L, Varich L, Logsdon G, Servaes S (2016) Imaging of sports-related injuries of the lower extremity in pediatric patients. Radiographics 36:1807–1827. https://doi.org/10.1148/rg.2016160009

    Article  PubMed  Google Scholar 

  20. Serafim TT, Oliveira ES, Migliorini F, Maffulli N, Okubo R (2022) Return to sport after conservative versus surgical treatment for pubalgia in athletes: a systematic review. J Orthop Surg Res 17:484. https://doi.org/10.1186/s13018-022-03376-y

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kraeutler MJ, Garabekyan T, Mei-Dan O (2016) The use of platelet-rich plasma to augment conservative and surgical treatment of hip and pelvic disorders. Muscles Ligaments Tendons J 6:410–419. https://doi.org/10.11138/mltj/2016.6.3.410

    Article  PubMed  PubMed Central  Google Scholar 

  22. Branci S, Thorborg K, Bech BH et al (2015) MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls. Br J Sports Med 49:681–691. https://doi.org/10.1136/bjsports-2014-093710

    Article  PubMed  Google Scholar 

  23. Branci S, Thorborg K, Nielsen MB et al (2013) Radiological findings in symphyseal and adductor-related groin pain in athletes: a critical review of the literature. Br J Sports Med 47:611–619. https://doi.org/10.1136/bjsports-2012-091905

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Alissa Kan for preparing the illustration in Fig. 1.

Author information

Authors and Affiliations

  1. Department of Radiology, The Ohio State University College of Medicine, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, 43205, OH, USA

    Rida Salman

  2. Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia

    Abeer Albar

  3. Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    J. Herman Kan

Authors
  1. Rida Salman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abeer Albar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Herman Kan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the paper conception and design. Material preparation was performed by Rida Salman and J Herman Kan. The first draft of the manuscript was written by Rida Salman and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rida Salman.

Ethics declarations

Ethics approval

Our institutional review board approved this retrospective Health Insurance Portability and Accountability Act (HIPAA)-compliant study, and patient consent was waived.

Consent to participate

Not applicable

Consent for publication

Not applicable

Conflicts of interest

None

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1 (DOCX 525 KB)

Supplementary Material 2 (MP4 4.30 MB)

Supplementary Material 3 (MP4 5.55 MB)

Supplementary Material 4 (MP4 4.55 MB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Salman, R., Albar, A. & Kan, J.H. MR imaging spectrum of adolescent pubic symphyseal injuries/athletic pubalgia. Pediatr Radiol (2024). https://doi.org/10.1007/s00247-024-05946-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00247-024-05946-0

Keywords

Search

Navigation