Sports-related groin pain secondary to symphysis pubis disorders: Correlation between MRI findings and outcome after fluoroscopy-guided injection of steroid and local anesthetic

Abstract

OBJECTIVE. The objective of our study was to correlate patterns of injury on preprocedural MRI with outcome after targeted fluoroscopy-guided steroid and local anesthetic injection of the symphysis pubis and its muscular attachments in a group of athletes with chronic groin pain. MATERIALS AND METHODS. Forty-five patients with chronic sports-related groin pain underwent MRI of the pelvis and a targeted fluoroscopy-guided symphyseal corticosteroid and local anesthetic injection. Preprocedural MRI was reviewed. The presence or absence of a "superior cleft" sign (i.e., rectus abdominis-adductor longus attachment microtearing), "secondary cleft" sign (i.e., short adductor [gracilis, adductor brevis, and pectineus muscles] attachment microtearing), osteitis pubis, and extrasymphyseal pelvic abnormalities was recorded. Patients were followed up a mean time of 23 months after the procedure, and outcome was recorded. Correlation was made between preprocedural MRI findings and outcome. RESULTS. Forty-two percent of the patients had an isolated superior cleft sign, 7% had an isolated secondary cleft sign, and 11% had isolated osteitis pubis. Thirty-one percent of patients had a more complex injury, and 9% had a normal symphysis pubis. Overall, 89% of the patients experienced an improvement in symptoms. The response was sustained after a minimum of 6 months in 58% of the patients. The presence of the superior cleft sign was more frequently associated with a complete recovery. CONCLUSION. Fluoroscopy-guided corticosteroid symphyseal injection is a safe and effective treatment of sports-related groin pain. It is more frequently associated with a complete recovery in patients who display an isolated superior cleft sign on MRI. MRI not only is useful in characterizing groin injuries but also may be helpful in predicting response to therapeutic injection.