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Patterns of Bone and Soft-Tissue Injury at the Symphysis Pubis in Soccer Players: Observations at MRI

Patricia M. Cunningham1, Darren Brennan, Martin O'Connell, Peter MacMahon, Pat O'Neill and Stephen Eustace

1 All authors: Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.


Figure 1
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  		Fig. 1A —22-year-old male soccer player from study group with left groin pain. Coronal inversion-recovery turbo spin-echo image shows secondary cleft (arrow) to left due to microtear at adductor attachment. Note normal symphyseal articular surfaces and absence of paraarticular bone edema.

 

Figure 2
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  		Fig. 1B —22-year-old male soccer player from study group with left groin pain. Radiograph obtained after cleft injection. Symphyseal injection confirms left-sided adductor microtear with subsequent symptom resolution after steroid (40 mg of prednisolone) and bupivacaine (1 mL of 0.5%) injection to cleft.

 

Figure 3
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  		Fig. 2A —27-year-old male soccer player from study group with long-standing bilateral groin pain that was worse on right side. Coronal inversion-recovery turbo spin-echo image shows secondary cleft (arrowhead) to right due to adductor enthetic microtear, accompanied by paraarticular bone edema and articular surface irregularity (arrow) due to osteitis pubis.

 

Figure 4
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  		Fig. 2B —27-year-old male soccer player from study group with long-standing bilateral groin pain that was worse on right side. Radiograph obtained after cleft injection. Symphyseal injection confirms presence of right adductor microtear (arrow) with symptom resolution after steroid (40 mg of prednisolone) and bupivacaine (1 mL of 0.5%) injection to cleft.

 

Figure 5
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  		Fig. 3A —32-year-old male soccer player from study group with right groin pain. Coronal inversion-recovery turbo spin-echo image (A) and axial T1-weighted turbo spin-echo image (B) show right-sided secondary cleft at site of adductor microtear without osteitis pubis. Axial image (B) shows posterior herniation of symphyseal fibrocartilage (arrow).

 

Figure 6
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  		Fig. 3B —32-year-old male soccer player from study group with right groin pain. Coronal inversion-recovery turbo spin-echo image (A) and axial T1-weighted turbo spin-echo image (B) show right-sided secondary cleft at site of adductor microtear without osteitis pubis. Axial image (B) shows posterior herniation of symphyseal fibrocartilage (arrow).

 

Figure 7
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  		Fig. 4 —Coronal T1-weighted image of 27-year-old soccer player in study group shows articular surface irregularity at symphysis pubis with superior articular surface stepoff, reflecting symphyseal laxity.

 

Figure 8
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  		Fig. 5A —Diagrams show secondary cleft. Diagram of symphysis pubis shows inferior attachment of adductor longus and gracilis conjoined tendon to inferior pubis (long arrow), passing over anterior pubis to merge with contralateral conjoined tendon and into inferior margin of symphyseal fibrocartilage. Rectus abdominis muscle (short arrow) attaches superiorly to superior margin of pubis, merges with contralateral rectus abdominis tendon, and merges inferiorly with conjoined tendon of adductor longus and gracilis muscles.

 

Figure 9
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  		Fig. 5B —Diagrams show secondary cleft. Diagram of symphysis pubis. Within fibrocartilage is physiologic cleft limited inferiorly by intact cartilage (arrow).

 

Figure 10
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  		Fig. 5C —Diagrams show secondary cleft. Diagram shows development of secondary cleft (arrow) due to tear at conjoined tendon attachment to inferior margin of fibrocartilage and at conjoined tendon enthesis.

 

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