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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 5/2021

15.01.2021 | HIP

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

verfasst von: Masayoshi Saito, Sadao Niga, Tadahiro Nihei, Mari Uomizu, Yuji Ikezawa, Sachiyuki Tsukada

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 5/2021

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Abstract

Purpose

To 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.

Methods

A 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.

Results

Four 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.

Conclusions

Multiple 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 evidence

III.
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Literatur
1.
Zurück zum Zitat Akaike H (1974) A new look at the statistical model identification. IEEE Trans Autom Control 19:215–222 Akaike H (1974) A new look at the statistical model identification. IEEE Trans Autom Control 19:215–222
2.
Zurück zum Zitat Ardern CL, Glasgow P, Schneiders A, Witvrouw E, Clarsen B, Cools A et al (2016) 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med 50:853–864CrossRef Ardern CL, Glasgow P, Schneiders A, Witvrouw E, Clarsen B, Cools A et al (2016) 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med 50:853–864CrossRef
3.
Zurück zum Zitat Branci S, Thorborg K, Bech BH, Boesen M, Nielsen MB, Holmich P (2015) MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls. Br J Sports Med 49:681–691CrossRef Branci S, Thorborg K, Bech BH, Boesen M, Nielsen MB, Holmich P (2015) MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls. Br J Sports Med 49:681–691CrossRef
4.
Zurück zum Zitat Branci S, Thorborg K, Nielsen MB, Holmich P (2013) Radiological findings in symphyseal and adductor-related groin pain in athletes: a critical review of the literature. Br J Sports Med 47:611–619CrossRef Branci S, Thorborg K, Nielsen MB, Holmich P (2013) Radiological findings in symphyseal and adductor-related groin pain in athletes: a critical review of the literature. Br J Sports Med 47:611–619CrossRef
5.
Zurück zum Zitat Clohisy JC, Carlisle JC, Beaule PE, Kim YJ, Trousdale RT, Sierra RJ et al (2008) A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am 90(Suppl 4):47–66CrossRef Clohisy JC, Carlisle JC, Beaule PE, Kim YJ, Trousdale RT, Sierra RJ et al (2008) A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am 90(Suppl 4):47–66CrossRef
6.
Zurück zum Zitat Daigeler A, Belyaev O, Pennekamp WH, Morrosch S, Koster O, Uhl W et al (2007) MRI findings do not correlate with outcome in athletes with chronic groin pain. J Sports Sci Med 6:71–76PubMedPubMedCentral Daigeler A, Belyaev O, Pennekamp WH, Morrosch S, Koster O, Uhl W et al (2007) MRI findings do not correlate with outcome in athletes with chronic groin pain. J Sports Sci Med 6:71–76PubMedPubMedCentral
7.
Zurück zum Zitat Dalton SL, Zupon AB, Gardner EC, Djoko A, Dompier TP, Kerr ZY (2016) The epidemiology of hip/groin injuries in National Collegiate Athletic Association Men’s and Women’s Ice Hockey: 2009–2010 through 2014–2015 Academic years. Orthop J Sports Med 4:2325967116632692CrossRef Dalton SL, Zupon AB, Gardner EC, Djoko A, Dompier TP, Kerr ZY (2016) The epidemiology of hip/groin injuries in National Collegiate Athletic Association Men’s and Women’s Ice Hockey: 2009–2010 through 2014–2015 Academic years. Orthop J Sports Med 4:2325967116632692CrossRef
8.
Zurück zum Zitat Dimitrakopoulou A, Schilders E (2016) Current concepts of inguinal-related and adductor-related groin pain. Hip Int 26(Suppl 1):2–7CrossRef Dimitrakopoulou A, Schilders E (2016) Current concepts of inguinal-related and adductor-related groin pain. Hip Int 26(Suppl 1):2–7CrossRef
9.
Zurück zum Zitat Drew MK, Lovell G, Palsson TS, Chiarelli PE, Osmotherly PG (2016) Do Australian football players have sensitive groins? Players with current groin pain exhibit mechanical hyperalgesia of the adductor tendon. J Sci Med Sport 19:784–788CrossRef Drew MK, Lovell G, Palsson TS, Chiarelli PE, Osmotherly PG (2016) Do Australian football players have sensitive groins? Players with current groin pain exhibit mechanical hyperalgesia of the adductor tendon. J Sci Med Sport 19:784–788CrossRef
10.
Zurück zum Zitat Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R (2010) Intrinsic risk factors for groin injuries among male soccer players: a prospective cohort study. Am J Sports Med 38:2051–2057CrossRef Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R (2010) Intrinsic risk factors for groin injuries among male soccer players: a prospective cohort study. Am J Sports Med 38:2051–2057CrossRef
11.
Zurück zum Zitat Falvey EC, King E, Kinsella S, Franklyn-Miller A (2016) Athletic groin pain (part 1): a prospective anatomical diagnosis of 382 patients–clinical findings, MRI findings and patient-reported outcome measures at baseline. Br J Sports Med 50:423–430CrossRef Falvey EC, King E, Kinsella S, Franklyn-Miller A (2016) Athletic groin pain (part 1): a prospective anatomical diagnosis of 382 patients–clinical findings, MRI findings and patient-reported outcome measures at baseline. Br J Sports Med 50:423–430CrossRef
12.
Zurück zum Zitat Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41:1149–1160CrossRef Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41:1149–1160CrossRef
13.
Zurück zum Zitat Gaudino F, Spira D, Bangert Y, Ott H, BeomonteZobel B, Kauczor HU et al (2017) Osteitis pubis in professional football players: MRI findings and correlation with clinical outcome. Eur J Radiol 94:46–52CrossRef Gaudino F, Spira D, Bangert Y, Ott H, BeomonteZobel B, Kauczor HU et al (2017) Osteitis pubis in professional football players: MRI findings and correlation with clinical outcome. Eur J Radiol 94:46–52CrossRef
14.
Zurück zum Zitat Hagglund M, Walden M, Ekstrand J (2013) Risk factors for lower extremity muscle injury in professional soccer: the UEFA Injury Study. Am J Sports Med 41:327–335CrossRef Hagglund M, Walden M, Ekstrand J (2013) Risk factors for lower extremity muscle injury in professional soccer: the UEFA Injury Study. Am J Sports Med 41:327–335CrossRef
15.
Zurück zum Zitat Haroy J, Clarsen B, Thorborg K, Holmich P, Bahr R, Andersen TE (2017) Groin problems in male soccer players are more common than previously reported. Am J Sports Med 45:1304–1308CrossRef Haroy J, Clarsen B, Thorborg K, Holmich P, Bahr R, Andersen TE (2017) Groin problems in male soccer players are more common than previously reported. Am J Sports Med 45:1304–1308CrossRef
16.
Zurück zum Zitat Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRef Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRef
17.
Zurück zum Zitat Lee SC, Endo Y, Potter HG (2017) Imaging of groin pain: Magnetic resonance and ultrasound imaging features. Sports Health 9:428–435CrossRef Lee SC, Endo Y, Potter HG (2017) Imaging of groin pain: Magnetic resonance and ultrasound imaging features. Sports Health 9:428–435CrossRef
18.
Zurück zum Zitat Lovell G, Galloway H, Hopkins W, Harvey A (2006) Osteitis pubis and assessment of bone marrow edema at the pubic symphysis with MRI in an elite junior male soccer squad. Clin J Sport Med 16:117–122CrossRef Lovell G, Galloway H, Hopkins W, Harvey A (2006) Osteitis pubis and assessment of bone marrow edema at the pubic symphysis with MRI in an elite junior male soccer squad. Clin J Sport Med 16:117–122CrossRef
19.
Zurück zum Zitat Mosler AB, Agricola R, Weir A, Holmich P, Crossley KM (2015) Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis. Br J Sports Med 49:810CrossRef Mosler AB, Agricola R, Weir A, Holmich P, Crossley KM (2015) Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis. Br J Sports Med 49:810CrossRef
20.
Zurück zum Zitat Mosler AB, Weir A, Eirale C, Farooq A, Thorborg K, Whiteley RJ et al (2018) Epidemiology of time loss groin injuries in a men’s professional football league: a 2-year prospective study of 17 clubs and 606 players. Br J Sports Med 52:292–297CrossRef Mosler AB, Weir A, Eirale C, Farooq A, Thorborg K, Whiteley RJ et al (2018) Epidemiology of time loss groin injuries in a men’s professional football league: a 2-year prospective study of 17 clubs and 606 players. Br J Sports Med 52:292–297CrossRef
21.
Zurück zum Zitat Naal FD, Miozzari HH, Kelly BT, Magennis EM, Leunig M, Noetzli HP (2013) The Hip Sports Activity Scale (HSAS) for patients with femoroacetabular impingement. Hip Int 23:204–211CrossRef Naal FD, Miozzari HH, Kelly BT, Magennis EM, Leunig M, Noetzli HP (2013) The Hip Sports Activity Scale (HSAS) for patients with femoroacetabular impingement. Hip Int 23:204–211CrossRef
22.
Zurück zum Zitat Omar IM, Zoga AC, Kavanagh EC, Koulouris G, Bergin D, Gopez AG et al (2008) Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics 28:1415–1438CrossRef Omar IM, Zoga AC, Kavanagh EC, Koulouris G, Bergin D, Gopez AG et al (2008) Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics 28:1415–1438CrossRef
23.
Zurück zum Zitat Paajanen H, Hermunen H, Karonen J (2008) Pubic magnetic resonance imaging findings in surgically and conservatively treated athletes with osteitis pubis compared to asymptomatic athletes during heavy training. Am J Sports Med 36:117–121CrossRef Paajanen H, Hermunen H, Karonen J (2008) Pubic magnetic resonance imaging findings in surgically and conservatively treated athletes with osteitis pubis compared to asymptomatic athletes during heavy training. Am J Sports Med 36:117–121CrossRef
24.
Zurück zum Zitat Paajanen H, Hermunen H, Ristolainen L, Branci S (2019) Long-standing groin pain in contact sports: a prospective case-control and MRI study. BMJ Open Sport Exerc Med 5:e000507CrossRef Paajanen H, Hermunen H, Ristolainen L, Branci S (2019) Long-standing groin pain in contact sports: a prospective case-control and MRI study. BMJ Open Sport Exerc Med 5:e000507CrossRef
25.
Zurück zum Zitat Paajanen H, Ristolainen L, Turunen H, Kujala UM (2011) Prevalence and etiological factors of sport-related groin injuries in top-level soccer compared to non-contact sports. Arch Orthop Trauma Surg 131:261–266CrossRef Paajanen H, Ristolainen L, Turunen H, Kujala UM (2011) Prevalence and etiological factors of sport-related groin injuries in top-level soccer compared to non-contact sports. Arch Orthop Trauma Surg 131:261–266CrossRef
26.
Zurück zum Zitat Ramazzina I, Bernazzoli B, Braghieri V, Costantino C (2019) Groin pain in athletes and non-interventional rehabilitative treatment: a systematic review. J Sports Med Phys Fitness 59:1001–1010CrossRef Ramazzina I, Bernazzoli B, Braghieri V, Costantino C (2019) Groin pain in athletes and non-interventional rehabilitative treatment: a systematic review. J Sports Med Phys Fitness 59:1001–1010CrossRef
27.
Zurück zum Zitat Reiman MP, Agricola R, Kemp JL, Heerey JJ, Weir A, van Klij P et al (2020) Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med 54:631–641CrossRef Reiman MP, Agricola R, Kemp JL, Heerey JJ, Weir A, van Klij P et al (2020) Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med 54:631–641CrossRef
28.
Zurück zum Zitat Saito M, Utsunomiya H, Hatakeyama A, Nakashima H, Nishimura H, Matsuda DK et al (2019) Hip arthroscopic management can improve osteitis pubis and bone marrow edema in competitive soccer players with femoroacetabular impingement. Am J Sports Med 47:408–419CrossRef Saito M, Utsunomiya H, Hatakeyama A, Nakashima H, Nishimura H, Matsuda DK et al (2019) Hip arthroscopic management can improve osteitis pubis and bone marrow edema in competitive soccer players with femoroacetabular impingement. Am J Sports Med 47:408–419CrossRef
29.
Zurück zum Zitat Schilders E, Talbot JC, Robinson P, Dimitrakopoulou A, Gibbon WW, Bismil Q (2009) Adductor-related groin pain in recreational athletes: role of the adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am 91:2455–2460CrossRef Schilders E, Talbot JC, Robinson P, Dimitrakopoulou A, Gibbon WW, Bismil Q (2009) Adductor-related groin pain in recreational athletes: role of the adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am 91:2455–2460CrossRef
30.
Zurück zum Zitat Serner A, Tol JL, Jomaah N, Weir A, Whiteley R, Thorborg K et al (2015) Diagnosis of acute groin injuries: a prospective study of 110 athletes. Am J Sports Med 43:1857–1864CrossRef Serner A, Tol JL, Jomaah N, Weir A, Whiteley R, Thorborg K et al (2015) Diagnosis of acute groin injuries: a prospective study of 110 athletes. Am J Sports Med 43:1857–1864CrossRef
31.
Zurück zum Zitat Serner A, van Eijck CH, Beumer BR, Holmich P, Weir A, de Vos RJ (2015) Study quality on groin injury management remains low: a systematic review on treatment of groin pain in athletes. Br J Sports Med 49:813CrossRef Serner A, van Eijck CH, Beumer BR, Holmich P, Weir A, de Vos RJ (2015) Study quality on groin injury management remains low: a systematic review on treatment of groin pain in athletes. Br J Sports Med 49:813CrossRef
32.
Zurück zum Zitat Serner A, Weir A, Tol JL, Thorborg K, Yamashiro E, Guermazi A et al (2020) Associations between initial clinical examination and imaging findings and return-to-sport in male athletes with acute adductor injuries: a prospective cohort study. Am J Sports Med 48:1151–1159CrossRef Serner A, Weir A, Tol JL, Thorborg K, Yamashiro E, Guermazi A et al (2020) Associations between initial clinical examination and imaging findings and return-to-sport in male athletes with acute adductor injuries: a prospective cohort study. Am J Sports Med 48:1151–1159CrossRef
33.
Zurück zum Zitat Silvis ML, Mosher TJ, Smetana BS, Chinchilli VM, Flemming DJ, Walker EA et al (2011) High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med 39:715–721CrossRef Silvis ML, Mosher TJ, Smetana BS, Chinchilli VM, Flemming DJ, Walker EA et al (2011) High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med 39:715–721CrossRef
34.
Zurück zum Zitat Trentacosta N, Sugimoto D, Micheli LJ (2017) Hip and groin injuries in dancers: a systematic review. Sports Health 9:422–427CrossRef Trentacosta N, Sugimoto D, Micheli LJ (2017) Hip and groin injuries in dancers: a systematic review. Sports Health 9:422–427CrossRef
35.
Zurück zum Zitat Tsukada S, Niga S, Nihei T, Imamura S, Saito M, Hatanaka J (2018) Iliopsoas disorder in athletes with groin pain: prevalence in 638 consecutive patients assessed with MRI and clinical results in 134 patients with signal intensity changes in the iliopsoas. JB JS Open Access 3:e0049CrossRef Tsukada S, Niga S, Nihei T, Imamura S, Saito M, Hatanaka J (2018) Iliopsoas disorder in athletes with groin pain: prevalence in 638 consecutive patients assessed with MRI and clinical results in 134 patients with signal intensity changes in the iliopsoas. JB JS Open Access 3:e0049CrossRef
36.
Zurück zum Zitat Verrall GM, Slavotinek JP, Fon GT (2001) Incidence of pubic bone marrow oedema in Australian rules football players: relation to groin pain. Br J Sports Med 35:28–33CrossRef Verrall GM, Slavotinek JP, Fon GT (2001) Incidence of pubic bone marrow oedema in Australian rules football players: relation to groin pain. Br J Sports Med 35:28–33CrossRef
37.
Zurück zum Zitat Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM et al (2015) Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 49:768–774CrossRef Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM et al (2015) Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 49:768–774CrossRef
38.
Zurück zum Zitat Werner J, Hagglund M, Walden M, Ekstrand J (2009) UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 43:1036–1040CrossRef Werner J, Hagglund M, Walden M, Ekstrand J (2009) UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 43:1036–1040CrossRef
39.
Zurück zum Zitat Zoga AC, Kavanagh EC, Omar IM, Morrison WB, Koulouris G, Lopez H et al (2008) Athletic pubalgia and the “sports hernia”: MR imaging findings. Radiology 247:797–807CrossRef Zoga AC, Kavanagh EC, Omar IM, Morrison WB, Koulouris G, Lopez H et al (2008) Athletic pubalgia and the “sports hernia”: MR imaging findings. Radiology 247:797–807CrossRef
40.
Zurück zum Zitat Zoga AC, Mullens FE, Meyers WC (2010) The spectrum of MR imaging in athletic pubalgia. RadiolClin North Am 48:1179–1197CrossRef Zoga AC, Mullens FE, Meyers WC (2010) The spectrum of MR imaging in athletic pubalgia. RadiolClin North Am 48:1179–1197CrossRef
Metadaten
Titel
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
verfasst von
Masayoshi Saito
Sadao Niga
Tadahiro Nihei
Mari Uomizu
Yuji Ikezawa
Sachiyuki Tsukada
Publikationsdatum
15.01.2021
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 5/2021
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-06410-w

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