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

Abstract

Objective

To determine the prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement and assess for correlative risk factors.

Materials and methods

A retrospective search identified 156 hips with femoroacetabular impingement and a control group of 113 without femoroacetabular impingement that had an MRI performed between January 1, 2015, and January 1, 2018. Two fellowship-trained musculoskeletal radiologists reviewed studies for the presence of acute osteitis pubis, chronic osteitis pubis, adductor tendinosis, and tendon tear; rectus abdominis tendinosis and tendon tear; and aponeurotic plate tear. Findings were correlated with various clinical and imaging risk factors. Univariate and multivariate statistical analyses were performed.

Results

Imaging findings of adductor tendinosis (p = 0.02) and chronic osteitis pubis (p = 0.01) were more prevalent in FAI patients than controls. Univariate analyses in FAI patients showed that an alpha angle ≥ 60° had a higher prevalence of aponeurotic plate tears (p = 0.02) and adductor tendinosis (p = 0.049). Multivariate analyses showed that an alpha angle ≥ 60° had a higher prevalence of chronic osteitis pubis (OR = 2.27, p = 0.031), sports participation had a higher prevalence of adductor tendon tears (OR = 4.69, p = 0.013) and chronic osteitis pubis (OR = 2.61, p = 0.0058), and males had a higher prevalence of acute osteitis pubis (OR = 5.17, p = 0.032).

Conclusion

Sports participation, alpha angle ≥ 60°, and male sex predict a higher prevalence of athletic pubalgia imaging findings in patients with femoroacetabular impingement.

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

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

References

  1. 1.

    Byrd JWT. Femoroacetabular impingement in athletes: current concepts. Am J Sports Med. 2014;42(3):737–51.

    Article  Google Scholar 

  2. 2.

    Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–20.

    Google Scholar 

  3. 3.

    Wyles CC, Norambuena GA, Howe BM, Larson DR, Levy BA, Yuan BJ, et al. Cam deformities and limited hip range of motion are associated with early osteoarthritic changes in adolescent athletes: a prospective matched cohort study. Am J Sports Med. 2017;45(13):3036–43.

    Article  Google Scholar 

  4. 4.

    Cohen B, Kleinhenz D, Schiller J, Tabaddor R. Understanding athletic pubalgia: a review. R I Med J. 2016;99(10):31–5.

    Google Scholar 

  5. 5.

    Strosberg DS, Ellis TJ, Renton DB. The role of femoroacetabular impingement in core muscle injury/athletic pubalgia: diagnosis and management. Front Surg. 2016;3:6.

    Article  Google Scholar 

  6. 6.

    Poor AE, Roedl JB, Zoga AC, Meyers WC. Core muscle injuries in athletes. Curr Sports Med Rep. 2018;17(2):54–8.

    Article  Google Scholar 

  7. 7.

    McSweeney SE, Naraghi A, Salonen D, Theodoropoulos J, White LM. Hip and groin pain in the professional athlete. Can Assoc Radiol J. 2012;63(2):87–99.

    Article  Google Scholar 

  8. 8.

    Zoga AC, Kavanagh EC, Omar IM, Morrison WB, Koulouris G, Lopez H, et al. Athletic pubalgia and the “sports hernia”: MR imaging findings. Radiology. 2008;247(3):797–807.

    Article  Google Scholar 

  9. 9.

    Omar IM, Zoga AC, Kavanagh EC, Koulouris G, Bergin D, Gopez AG, et al. Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics. 2008;28(5):1415–38.

    Article  Google Scholar 

  10. 10.

    Birmingham PM, Kelly BT, Jacobs R, McGrady L, Wang M. The effect of dynamic femoroacetabular impingement on pubic symphysis motion: a cadaveric study. Am J Sports Med. 2012;40(5):1113–8.

    Article  Google Scholar 

  11. 11.

    Larson CM, Pierce BR, Giveans MR. Treatment of athletes with symptomatic intra-articular hip pathology and athletic pubalgia/sports hernia: a case series. Arthroscopy. 2011;27(6):768–75.

    Article  Google Scholar 

  12. 12.

    Saito M, Utsunomiya H, Hatakeyama A, Nakashima H, Nishimura H, Matsuda DK, et al. Hip arthroscopic management can improve osteitis pubis and bone marrow edema in competitive soccer players with femoroacetabular impingement. Am J Sports Med. 2019;47(2):408–19.

    Article  Google Scholar 

  13. 13.

    Sansone M, Ahldén M, Jonasson P, Thomeé R, Falk A, Swärd L, et al. Can hip impingement be mistaken for tendon pain in the groin? A long-term follow-up of tenotomy for groin pain in athletes. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):786–92.

    Article  Google Scholar 

  14. 14.

    Munegato D, Bigoni M, Gridavilla G, Olmi S, Cesana G, Zatti G. Sports hernia and femoroacetabular impingement in athletes: a systematic review. World J Clin Cases. 2015;3(9):823–30.

    Article  Google Scholar 

  15. 15.

    Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84(4):556–60.

    Article  Google Scholar 

  16. 16.

    Tallroth K, Lepistö J. Computed tomography measurement of acetabular dimensions: normal values for correction of dysplasia. Acta Orthop. 2006;77(4):598–602.

    Article  Google Scholar 

  17. 17.

    Hernandez RJ, Tachdjian MO, Poznanski AK, Dias LS. CT determination of femoral torsion [Internet]. Am J Roentgenol. 1981;137:97–101. https://doi.org/10.2214/ajr.137.1.97.

    CAS  Article  Google Scholar 

  18. 18.

    Anda S, Terjesen T, Kvistad KA. Computed tomography measurements of the acetabulum in adult dysplastic hips: which level is appropriate? Skelet Radiol. 1991;20(4):267–71.

    CAS  Article  Google Scholar 

  19. 19.

    Brennan D, O’Connell MJ, Ryan M, Cunningham P, Taylor D, Cronin C, et al. Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology. 2005;235(1):162–7.

    Article  Google Scholar 

  20. 20.

    Hammoud S, Bedi A, Magennis E, Meyers WC, Kelly BT. High incidence of athletic pubalgia symptoms in professional athletes with symptomatic femoroacetabular impingement. Arthroscopy. 2012;28(10):1388–95.

    Article  Google Scholar 

  21. 21.

    Larson CM, Sikka RS, Sardelli MC, Byrd JWT, Kelly BT, Jain RK, et al. Increasing alpha angle is predictive of athletic-related “hip” and “groin” pain in collegiate National Football League prospects. Arthroscopy. 2013;29(3):405–10.

    Article  Google Scholar 

  22. 22.

    Verrall GM, Slavotinek JP, Barnes PG, Esterman A, Oakeshott RD, Spriggins AJ. Hip joint range of motion restriction precedes athletic chronic groin injury. J Sci Med Sport. 2007;10(6):463–6.

    Article  Google Scholar 

  23. 23.

    Verrall GM, Hamilton IA, Slavotinek JP, Oakeshott RD, Spriggins AJ, Barnes PG, et al. Hip joint range of motion reduction in sports-related chronic groin injury diagnosed as pubic bone stress injury. J Sci Med Sport. 2005;8(1):77–84.

    CAS  Article  Google Scholar 

  24. 24.

    Weir A, de Vos RJ, Moen M, Hölmich P, Tol JL. Prevalence of radiological signs of femoroacetabular impingement in patients presenting with long-standing adductor-related groin pain. Br J Sports Med. 2011;45(1):6–9.

    CAS  Article  Google Scholar 

  25. 25.

    Feeley BT, Powell JW, Muller MS, Barnes RP, Warren RF, Kelly BT. Hip injuries and labral tears in the national football league. Am J Sports Med. 2008;36(11):2187–95.

    Article  Google Scholar 

  26. 26.

    Kavroudakis E, Karampinas PK, Evangelopoulos DS, Vlamis J. Treatment of osteitis pubis in non-athlete female patients. Open Orthop J. 2011;5:331–4.

    CAS  Article  Google Scholar 

  27. 27.

    Angoules AG. Osteitis pubis in elite athletes: diagnostic and therapeutic approach. World J Orthop. 2015;6(9):672–9.

    Article  Google Scholar 

  28. 28.

    Kennedy MJ, Lamontagne M, Beaulé PE. Femoroacetabular impingement alters hip and pelvic biomechanics during gait walking biomechanics of FAI. Gait Posture. 2009;30(1):41–4.

    Article  Google Scholar 

  29. 29.

    Hammoud S, Bedi A, Voos JE, Mauro CS, Kelly BT. The recognition and evaluation of patterns of compensatory injury in patients with mechanical hip pain. Sports Health. 2014;6(2):108–18.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Sowmya Varada.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

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

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

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Varada, S., Moy, M.P., Wu, F. et al. The prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement. Skeletal Radiol 49, 1249–1258 (2020). https://doi.org/10.1007/s00256-020-03405-z

Download citation

Keywords

  • Musculoskeletal
  • MRI
  • Femoroacetabular impingement
  • Cam
  • Pincer
  • Athletic pubalgia
  • Osteitis pubis
  • Adductor
  • Rectus abdominis
  • Aponeurotic plate