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Cadaveric and MRI Study of the Musculotendinous Contributions to the Capsule of the Symphysis Pubis

¹ Department of Radiology, Leeds Teaching Hospitals, Musculoskeletal Centre, Chapel Allerton Hospital, Leeds LS7 4SA, United Kingdom.
² Division of Anatomy, Department of Surgery, University of Toronto, Toronto, ON, Canada.
³ Clinical Science Department, Philips Medical Systems, Surrey, United Kingdom.
⁴ Department of Orthopedic Surgery, Bradford Royal Infirmary, Bradford, United Kingdom.

View larger version (166K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Male cadaver dissection, normal anatomy. Photograph of anterolateral view. Asterisks mark center of symphysis pubis. Tendinous attachment of adductor longus (AL) to tissue overlying anterior symphysis pubis is elevated by pin (thin white line) and inferiorly outlined with arrows. Pyramidalis (P) is reflected to reveal rectus abdominis (RA). Medial margin of adductor brevis (AB) can be seen medial to AL.

View larger version (166K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Male cadaver dissection, normal anatomy. Photograph of same specimen as in A with AL reflected. Pins (thin white lines) demarcate tendinous attachments of AL and AB to tissue overlying anterior symphysis pubis. Asterisks mark center of symphysis pubis.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Male cadaver dissection, normal anatomy. Photograph of fresh specimen axial section shows trabeculae of pubic bones (P) with interdigitating hyaline cartilage (large arrows) and fibrocartilage disk (D). Disk and cartilage merge with anterior aponeurotic tissues (small arrows). Right adductor longus (between asterisks) is elevated by pin and is seen contributing to anterior soft tissues.

View larger version (68K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Male cadaver dissection, normal anatomy. Line diagram shows relative position of tendinous attachments with direction (arrows) of involvement over symphyseal capsular tissues.

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Sequential axial T1-weighted fast-field echo (TR/TE, 25/4.9) spectral inversion recovery fat-suppressed MR images in 28-year-old male athlete with no previous pubalgia and normal anatomy. Image at level just superior to pubic tubercle shows pubic bodies (P) with intervening disk (arrow) and rectus abdominis tendon (arrowheads) closely applied to anterior capsular tissues.

View larger version (162K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Sequential axial T1-weighted fast-field echo (TR/TE, 25/4.9) spectral inversion recovery fat-suppressed MR images in 28-year-old male athlete with no previous pubalgia and normal anatomy. Image at level of pubic tubercle shows continuation of rectus abdominis tendon centrally (arrowhead) with contributions from two adductor longus tendons (arrows) lying medial to tubercle on this occasion. Right pubic subchondral cysts (asterisks) are noted.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Sequential axial T1-weighted fast-field echo (TR/TE, 25/4.9) spectral inversion recovery fat-suppressed MR images in 28-year-old male athlete with no previous pubalgia and normal anatomy. Image inferior in relation to B shows rectus abdominis condensation is now quite faint (arrowhead) with more definite adductor longus tendons visualized (arrows).

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Sequential axial T1-weighted fast-field echo (TR/TE, 25/4.9) spectral inversion recovery fat-suppressed MR images in 28-year-old male athlete with no previous pubalgia and normal anatomy. Image inferior in relation to C shows fully formed low-signal adductor longus tendons (arrows).

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Sagittal T1-weighted fast-field echo (TR/TE, 25/4.9) MR images in 29-year-old male athlete who had experienced previous pubalgia show normal anatomy. Image shows edge of fibrocartilaginous disk (D) with interdigitating hyaline cartilage and pubic bone (black arrowheads). Anteriorly, capsular tissues (white arrowheads) merge with disk and rectus abdominis tendon (arrow). Pyramidalis is present anteriorly (asterisk).

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Sagittal T1-weighted fast-field echo (TR/TE, 25/4.9) MR images in 29-year-old male athlete who had experienced previous pubalgia show normal anatomy. Image lateral to A shows pubic marrow and cortex (P) with thin layer of intermediate-signal hyaline cartilage (small arrowheads) closely applied to anterior capsular tissues (between large arrowheads). Merging with this tissue are rectus abdominis muscle (RAb), pyramidalis (asterisk), superficial adductor longus tendon (arrows), deeper muscle (AL), and adductor brevis (ABr) muscle.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Axial T1-weighted fast-field echo (TR/TE, 25/4.9) spectral inversion recovery fat-suppressed IV gadolinium-enhanced MR images in 23-year-old male athlete who had experienced previous pubalgia show lateral adductor longus tendon insertion. Image at level just superior to pubic tubercle pyramidalis (small arrow) and rectus abdominis tendon (arrowhead) shows they are applied to capsular tissues. There is right-sided pubic bone marrow enhancement and edema (large arrows).

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Axial T1-weighted fast-field echo (TR/TE, 25/4.9) spectral inversion recovery fat-suppressed IV gadolinium-enhanced MR images in 23-year-old male athlete who had experienced previous pubalgia show lateral adductor longus tendon insertion. Image inferior in relation to A and just inferior in relation to pubic tubercle shows adductor longus tendons (arrows) before attachment to tubercle. They have more lateral course in comparison with those in Figure 2A, 2B, 2C, 2D. Rectus abdominis tendon is seen anteriorly (arrowhead).

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Axial T1-weighted fast-field echo (TR/TE, 25/4.9) spectral inversion recovery fat-suppressed IV gadolinium-enhanced MR images in 23-year-old male athlete who had experienced previous pubalgia show lateral adductor longus tendon insertion. Image inferior in relation to B shows rectus abdominis tissue (arrowheads) closely applied to anterior capsular tissues but also merging with adjacent adductor longus tendons (arrows).

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —17-year-old male athlete with no previous pubalgia who has normal apophysis. Axial T1-weighted fast-field echo (TR/TE, 25/4.9) spectral inversion recovery fat-suppressed MR image shows low-signal subchondral pubic cortex (large arrowheads) with intervening high-signal apophyseal cartilage and areas of enchondral ossification (small arrowheads) merging with capsular tissues and rectus abdominis tendon (arrow).

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —17-year-old male athlete with no previous pubalgia who has normal apophysis. Sagittal T1-weighted fast-field echo (25/4.9) spectral inversion recovery fat-suppressed MR image lateral to disk shows pubis (P) still with covering of hyaline cartilage (large arrowhead) and low-signal enchondral ossification (between small arrowheads). Anterior soft tissues consist of rectus abdominis (small arrow) and adductor longus tendons and fascia (large arrow).

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —28-year-old male athlete with no previous pubalgia who has primary cleft. Axial T1-weighted fast-field echo (TR/TE, 25/4.9) spectral inversion recovery fat-suppressed IV gadolinium-enhanced MR image shows low-signal fibrocartilaginous disk (arrowhead) with high-signal cleft (arrow).

View larger version (160K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7 —20-year-old male athlete with no previous pubalgia who has apophyseal enhancement. Axial T1-weighted fast-field echo (TR/TE, 25/4.9) spectral inversion recovery fat-suppressed IV gadolinium-enhanced MR image shows enhancing vessels (arrows) extending from subchondral bone into apophyseal cartilage and ossification.

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