Adam C. Zoga MD, Presenter: Speakers Bureau, Bayer AG (Berlex Inc)

William B. Morrison MD, Abstract Co-Author: Nothing to Disclose

Eoin Carl Kavanagh MD, Abstract Co-Author: Nothing to Disclose

Imran Muhammad Omar MD, Abstract Co-Author: Nothing to Disclose

Hector Lopez, Abstract Co-Author: Nothing to Disclose

William C. Meyers MD, Abstract Co-Author: Nothing to Disclose

Angela Gessner Gopez MD, Abstract Co-Author: Nothing to Disclose

George Koulouris MBBS, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To further define the anatomy and pathologies seen on MRI in patients with athletic pubalgia using clinical and surgical correlation, as well as cadaveric study.

115 patients (mean age: 31.8, M/F: 98/17) with athletic pubalgia had MRI using a dedicated pubalgia protocol. Osseous, articular, tendinous, muscular and abdominal wall findings were recorded. MRI was compared with clinical and operative findings as well as treatment plan. Ten cadaveric dissections (5M:5F) were performed dedicated soft tissue anatomy about the symphysis and inguinal ring and compared with MRI.

At dissection, the caudal attachment of the rectus abdominis (RA) just lateral to the symphysis and superficial to the external ring was confluent with the origin of the thigh adductors in 10/10. This was termed the rectus/adductor aponeurosis. At MRI, 83/115 patients (72%) had tears (71) or degeneration (12) at the aponeurosis. Lesions were most frequent at its lateral edge (44/83, 53%) with fewer lesions medial (18) or spanning the aponeurosis (21). 29/83 lesions (35%), including 4 in 17 females (24%), extended across midline where bilateral RA attachments resembled an aponeurotic plate. 82/115 patients (71%) had bone marrow edema about the symphysis but in 75/82 (91%), it was asymmetric to the side of pain and in 62 (76%), it involved only the anterior pubis subjacent to the aponeurosis. A T2 hyperintense secondary cleft was present in 78/115 patients(68%). 15/115 patients (13%) had findings of osteitis pubis and only 5 (4%) had findings isolated to the thigh adductors. 74 patients went to surgery. MR findings of asymmetric bone marrow edema (54, 73%), a secondary cleft (61, 82%) and an aponeurotic lesion (64, 86%) correlated highly with surgical treatment.

Confluent tendinous lesions spanning the lateral edge of the caudal rectus abdominis attachment and the origin of the thigh adductors are common in patients with athletic pubalgia. Injury at this aponeurosis frequently yields asymmetric bone marrow edema in the anterior pubis and a secondary cleft on MRI.

Lesions involving the rectus abdominis/adductor aponeurotic plate on MRI should be recognized as a potential cause of athletic pubalgia.

Zoga, A, Morrison, W, Kavanagh, E, Omar, I, Lopez, H, Meyers, W, Gopez, A, Koulouris, G, et al, , et al, , MRI of Athletic Pubalgia: The Rectus Abdominis/Adductor Aponeurotic Plate.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5016115.html