The cleft sign may be an independent factor of magnetic resonance imaging findings associated with a delayed return-to-play time in athletes with groin pain

Abstract

PurposeTo investigate the prevalence of magnetic resonance imaging (MRI) findings and define prognostic factors of the return‐to‐play time in young athletes with groin pain. MethodsA total of 1091 consecutive athletes were retrospectively screened; 651 athletes, aged 16–40 years, with pain in the groin regions were assessed using MRI. Of these athletes, 356 were included for analysing the time to return‐to‐play. Univariate and multiple linear regression analyses were used to determine the associations between the time to return‐to‐play (primary outcome variable) and the following variables: age, sex, body mass index, type of sports, Hip Sports Activity Scale, clear trauma history, and 12 MRI findings. ResultsFour MRI findings, including cleft sign, pubic bone marrow oedema of both the superior and inferior ramus, and central disc protrusion of the pubic symphysis, appeared together in more than 44% of the cases. The median time to return‐to‐play was 24.7 weeks for athletes with a cleft sign on MRI, which was significantly longer than the 11.9 weeks for athletes without the sign. The median time to return‐to‐play was 20.8 weeks for athletes with BMI > 24, which was significantly longer than the 13.6 weeks for athletes with BMI ≦ 24.In multiple linear regression analysis of 356 athletes, in whom hip‐related groin pain was excluded, and who were followed‐up until the return‐to‐play, the body mass index and cleft sign were the independent factors associated with a delayed return‐to‐play. In contrast, iliopsoas muscle strain and other muscle injuries were associated with a shorter return‐to‐play. ConclusionsMultiple MRI findings were present in almost half of all cases. Body mass index and the cleft sign were independently associated with a delayed return‐to‐play time in young athletes suffering from groin pain. Level of evidenceIII.

Cleft Sign and Bone Marrow Edema of the Pubic Symphysis Are Associated With Sports and Bony Morphology in Patients With Femoroacetabular Impingement and Labral Tears

“…Moreover, in a recent series of 1091 athletes with groin pain, multiple MRI findings, including CS and pubic BME, were found in 56.5% of athletes. 24 The authors noted that body mass index and CS were independently associated with a delayed return to play. Our findings support the claim that contact sports players (including soccer players) show more frequent BME: specifically, contact sports players with FAI had a higher prevalence of SCS, ICS, and BME than did noncontact sports players.…”

“… 6 , 19 CS and bone marrow edema (BME) of the pubis are strongly associated with hip and groin pain in athletes. 11 , 24 …”

“…6,19 CS and bone marrow edema (BME) of the pubis are strongly associated with hip and groin pain in athletes. 11,24 Several studies have investigated the relationship between femoroacetabular impingement (FAI) and osteitis pubis. It has been reported that repetitive loading of the symphysis secondary to cam morphology and impingement was likely a precursor to groin pain and athletic pubalgia via increased motion at the symphysis pubis.…”

Pain provocation tests and clinical entities in male football players with longstanding groin pain are associated with pain intensity and disability

“…However, clear relationships between tissue injuries/pathology and longstanding groin pain classified into clinical entities using pain provocation tests are still lacking (Drew et al, 2014;Ishøi et al, 2021). Furthermore, the associations between longstanding groin pain and abnormal radiological findings lack robustness, temporal validity, and consistency (Branci et al, 2013Heerey et al, 2020;Massa et al, 2020;Paajanen et al, 2019;Robinson et al, 2015;Saito et al, 2021;Serner et al, 2021;Tsukada et al, 2018).…”

Soccer players show the highest seasonal groin pain prevalence and the longest time loss from sport among 500 athletes from major team sports

“…This study has several limitations. First, given the study’s cross‐sectional design, we were unable to perform clinical or radiological examination [32, 36] to assess strength, hip joint range of motion, and discriminate among the five major subheadings for athletes with groin pain of the Doha system [52]. Second, we also did not report information on any conservative or surgical treatments performed.…”