In Irish soccer players with pubalgia, adductor dysfunction is a more frequent MRI finding than osteitis pubis. In a recent study published in the American Journal of Roentgenology (AJR 2007; 188:W291-W296); Dr. Patricia M. Cunningham and colleagues from the Department of Radiology Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland, showed soccer players with pubalgia, adductor dysfunction is a more frequent MRI finding than osteitis pubis.

Dr. Cunningham and her researchers aim was to use MRI to determine the prevalence of osteitis pubis and adductor dysfunction at the Symphysis pubis in soccer players presenting with pubalgia as well as establish whether the two entities are mechanically related. This also included whether one precedes or predisposes the development of the other.

In this study 100 consecutive soccer players were referred to MRI in addition to another 100 elite matched athletes included for the control group. Images were reviewed independently by two radiologists who were blinded to the side of symptoms.

Researchers found that in 100 patients groin pain was directly attributed to inflammation at the symphysis pubis or in 97 patients, its muscular attachments. In 88 of these patients ‘accessory cleft’, reflecting an adductor enthetic microtear, was identified and correlated with the side of symptoms in all cases.

In 91 of the 100 patients bone edema was identified: 49 patients had focal edema at the attachment site of the adductor tendons accompanying an adductor microtear, two patients had focal edema without an adductor tear, and 40 patients had diffuse edema in the pubic bones secondary to osteitis pubis. There was no evidence of either adductor dysfunction or symphyseal inflammation in the control subjects

Dr Cunningham notes the finding of the study suggests "both entities are mechanically related and that osteitis pubis and adductor dysfunction frequently coexist but, because adductor dysfunction is commonly identified in the absence of osteitis, that adductor dysfunction most likely precedes the development of osteitis pubis in soccer players".

Cummings and her team also add that: "The presence of edema on fat-suppressed images of the Symphysis is a strong predictor of abnormality at this site in soccer players when compared with control subjects."

Online abstract: http://www.ajronline.org/cgi/content/abstract/188/3/W291?rss=1

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