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Inferior Pubic Ligament Injury: Magnetic Resonance Imaging Assessment in Athletes With Pubic-Related Groin Pain
Thomas Mathieu1,2, Francis Van Glabbeek1,3, Luc Van Nassauw1
1Research Group of ASTARC (Antwerp Surgical Training, Anatomy and Research Centre), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
Background:
Many athletes experience pubalgia. Although much is known about ligament injuries in other joints, the importance of ligament injuries in the pubic joint remains understudied.
Purpose:
To determine the frequency of an inferior pubic ligament (IPL) injury on magnetic resonance imaging (MRI) in a population of athletes with isolated pubic-related groin pain and to compare this group with a control group of athletes with adductor-related groin pain to assess the clinical relevance and association of an IPL injury with pubic-related groin pain.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
Inclusion criteria consisted of athletes with pubic-related groin pain. All included participants were given a standardized questionnaire, a clinical examination, and a MRI examination of the pelvis. All MRI scans were reviewed to assess the IPL and other pubic-related pathologies, including pubic bone marrow edema and adductor injuries. The prevalence of an IPL lesion in patients with pubic-related groin pain is reported with the 95% confidence interval (95% CI). A control group with adductor-related groin pain was retrospectively included for comparison. Group characteristics were compared using the Pearson χ2 test, Fisher exact test, and Mann-Whitney-Wilcoxon test. Risk factors of IPL injury were analyzed by logistic regression.
Results:
A total of 60 athletes were included (56 male, 4 female); 18% showed definite MRI signs of IPL injury. In addition, 15% showed an equivocal IPL abnormality. This resulted in an IPL lesion prevalence of 33% (95% CI, 23%-46%) in this group. Of the 20 athletes with an IPL injury, 18 were soccer players and 2 were track and field athletes. All were men. The median age was 30 years (IQR, 26-36). The risk of IPL lesion was significantly higher in patients with trauma (odds ratio, 8.76; 95% CI, 2.56-29.91; P < .001). No IPL lesions were observed in the control group of 28 athletes with adductor-related groin pain (P < .001).
Conclusion:
On the basis of MRI analysis, there is a relatively high frequency of IPL injuries (33%) in athletes with pubic-related groin pain in addition to pubic bone and adductor pathology. No IPL injuries (0%) were observed in a control group of athletes with adductor-related groin pain. Our findings support the consideration of IPL injury in the diagnostic workup of pubic-related groin pain, particularly in posttraumatic cases. Further research is needed to refine the diagnostic process and to better understand the implications of IPL injury for rehabilitation and return-to-play outcomes.
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