Jordan Gold MD, Presenter: Nothing to Disclose

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

Johannes B. Roedl MD, PhD, Abstract Co-Author: Nothing to Disclose

William B. Morrison MD, Abstract Co-Author: Consultant, General Electric Company Consultant, AprioMed AB Patent agreement, AprioMed AB Consultant, Zimmer Holdings, Inc

Adam C. Zoga MD, Abstract Co-Author: Nothing to Disclose

Anecdotally, we noted a focal soft tissue breach located anterior to the midline pubic symphysis with horizontal orientation on sagittal MR imaging in patients with clinical athletic pubalgia. We sought to establish the incidence of this “incipient breach” and explore its clinical and MR associations, as well as explore its role in the evolution of athletic pubalgia injuries.

80 consecutive cases referred for MR from an athletic pubalgia specialty clinic were reviewed. The presence of an incipient breach, as well as any rectus abdominis/adductor (RA-AL) aponeurosis or midline pubic plate lesion were recorded and localized, as were presence of a secondary cleft, subapophyseal defect and osteitis pubis (classified as mild, moderate, severe). Age and gender were recorded along with any athletic activity, clinical examination findings and treatment planning, and all were correlated with the presence of an incipient breach. A control group of 20 subjects imaged for hip lesions was reviewed.

79/80 study subjects had athletic pubalgia lesions at MRI. The incipient breach was identified on sagittal images in 61% (49/80) of study subjects. In patients with primary midline pubic plate lesions, 82% (42/51) showed an incipient breach. In patients with a primary unilateral RA-AL aponeurosis lesions, the incidence of an incipient breach was 21% (6/28). Moderate or severe osteitis pubis was identified in 49% of patients with an incipient breach (24/49), compared with 35% of patients without the lesion (11/31). 20/25 patients with an incipient breach were also noted to have a secondary cleft by MR. Football players accounted for majority of referred patients at 45% with 25/36 (69%) showing an incipient breach, while baseball and soccer players each accounted for 7.5% of the study group with 66% and 50% having incipient breaches respectively. 44/49 of patients with an incipient breach were treated with surgical pelvic floor repair.

An incipient breach is a common and potentially important observation in an athletic pubalgia patient population. This finding should be observed on sagittal imaging at midline and reported.

The genesis of athletic pubalgia is long debated with many focusing on a musculoskeletal source. The incipient breach may reflect this initial injury, particularly in patients with midline lesions.

Gold, J, Meyers, W, Roedl, J, Morrison, W, Zoga, A, The Incipient Breach of the Midline Pubic Plate: Is this MRI Finding Key to Early Diagnosis and Prevention of Athletic Pubalgia?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004705.html