MRI case studies
| Study | Slavotinek et al (2005) | Schilders et al (2007) | Schilders et al (2009) | Kunduraciogluet al (2007) | Albers et al (2001) | Lovell et al (2006) |
|---|---|---|---|---|---|---|
| Case-study group participants (incl. sports type, gender, age) | 52 athletes (Australian football) Male. Age: 17–31 | 24 athletes (19 soccer, 2 rugby, 2 runners, 1 squash) Male. Age: 19–41 | 28 recreational athletes (14 soccer, 6 rugby, 3 golf, 2 squash, 2 cycling, 1 swimming, 1 triathlon) Gender unknown. Age 18–50 | 22 athletes (21 soccer, 1 handball) Male. Age 17–43 | 30 athletes (16 soccer, 5 football, other sports) 29 Male, 1 Female. Age 18–40 | 19 athletes (Australian football) Male. Age 15–17 |
| Inclusion criteria | Athletes from two teams of the Australian Football League with or without groin pain | Competitive athletes, clinical adductor dysfunction, failure of non-operative treatment (rest, ice, NSAID, physiotherapy) | Recreational athletes, participate in sports <4 days/week, clinical adductor dysfunction, failure of non-operative treatment (rest, ice, NSAID, physiotherapy) | Elite athletes referred to sports clinic with a possible diagnosis of osteitis pubis and duration of symptoms >6 weeks | Patients with pubalgia who are surgically confirmed as having pubalgia caused by abnormal musculofascial abnormalities (PAMA) | Athletes from the Australian Institute of Sports, training 2 months prior to start of the study |
| Exclusion criteria | Athletes with pain not located in the pubic symphysis, pubic bones, adductor area or lower abdominal area | Any clinical evidence of sports hernia or osteitis pubis. Any clinical or radiographic evidence of pathological involvement of hip joints | Any clinical evidence of sports hernia or osteitis pubis. Any clinical or radiographic evidence of pathological involvement of hip joints | Not described | Not described | Not described |
| Clinical findings (1) type of examination (2)findings | (1)Not reproducible (2) 23 athletes have current groin pain, 18 a history of groin pain; 39 have tenderness on palpation of symphysis or adductor origin | (1)Reproducible (a.m. Hölmich) (2) all athletes have unilateral adductor dysfunction at clinical examination | (1)Reproducible (a.m. Hölmich) (2) all athletes have unilateral adductor dysfunction at clinical examination | (1) Not described (2) all athletes have tenderness on palpation of symphysis. 6 have bilateral and 16 have unilateral groin pain. 6 athletes have pain at adductor muscle origin | (1) Not described (2) 17 athletes with bilateral and 13 athletes with unilateral groin pain | (1) Not described (2) one athlete with groin pain and tenderness at pubic symphysis at the start of the study |
| Diagnostic entity used by authors | Not defined | Clinical adductor dysfunction | Clinical adductor dysfunction | Osteitis pubis | Pubalgia | Osteitis pubis |
| Radiology protocol (1) field strength and (2) sequences | (1) 1.5T and 1.0T and (2) coronal and axial T1& T2 FatSat | (1) 1.5 T and (2) coronal STIR, axial oblique T1 and axial oblique and sagittal T1 FatSat postintravenous gadolinium | (1) 1.5T and (2) coronal STIR, axial T2, axial oblique T2 FatSat and axial oblique and sagittal T1 FatSat postintravenous gadolinium | (1) 1.5T and (2) coronal T1 and STIR, axial T2 | (1) 1.5T and (2) coronal and axial T1&T2, axial STIR | (1) 1.5 T and (2) coronal T1&STIR, axial STIR, athletes scanned three times (at start and after 2 and 4 months) |
| Additional radiological examinations | None | Pelvic radiographs | Pelvic radiographs | None | None | Extra MRI scan if athlete develops pain during study |
| Evaluation of MRI scans | 2 Radiologists blinded to clinical details. Diagnosis by consensus. BMO (graded 0–3 and extent >2 cm) Degenerative changes at symphyseal joint | 1 Radiologist with full clinical details Presence of contrast enhancement at adductor muscle origin | 1 Radiologist with full clinical details Presence of contrast enhancement at adductor muscle origin | 1 Radiologist with full clinical details BMO (not graded) Degenerative changes at symphyseal joint | 2 Radiologists blinded to clinical details. Diagnosis by consensus BMO (not graded) Degenerative changes at symphyseal joint Musculotendinous structures of the groin and abdominal wall. Inguinal hernia, hip and SI joints | 2 Radiologists blinded to clinical details. Diagnosis by consensus BMO (graded 0–3) Degenerative changes at symphyseal joint Adductor muscle origin Inguinal hernia |
| Reproducibility of radiology | Interobserver agreement | None | None | None | None | None |
| ‘Gold standard’ used | None | Ultrasound-guided injection of local anaesthetic and steroid in symphyseal joint to treat pain | Ultrasound-guided injection of local anaesthetic and steroid in symphyseal joint to treat pain | None | Surgery (modified Bassini hernioplasty) | None |
| Conclusions/results | 17 of 39 athletes have groin tenderness, and 19 of the total 52 athletes have severe BMO Interobserver agreement for grading of BMO : κ=0.85 (good) | 17 athletes with contrast enhancement at adductor muscle origin (enthesitis): 12 athletes with gradual onset of pain, 5 with acute onset 7 athletes without contrast enhancement at adductor muscle origin No evidence of femoroacetabular impingement on radiographs | 13 athletes with contrast enhancement at adductor muscle origin (enthesitis) 15 athletes without contrast enhancement at adductor muscle origin No evidence of femoroacetabular impingement on radiographs | 14 athletes with BMO Degenerative changes present in 50% of the group of athletes | 21 athletes with BMO, which in 20 corresponds to side of surgery 18 athletes with increased signal at adductor muscle origin 6 athletes with increased signal in pectineus muscle, 27 with attenuation of abdominal musculofascial layers | 1 athlete with groin pain at start of study. 4 Athletes develop pain during study Initially BMO in 11 athletes. Increase in severity of BMO during the training season. BMO present in 2/3 of asymptomatic athletes |
BMO, bone marrow oedema.