Myriame Bou Antoun1, Maxime Ronot2, Amandine Crombe3, Marie-Hélène Moreau-Durieux4, Gilles Reboul5, Lionel Pesquer6. 1. Department of Radiology, HEGP Hospital, Assistance publique- hôpitaux de Paris (AP-HP), University of Paris V, Paris, France. 2. Department of Radiology, Beaujon Hospital, Assistance publique- hôpitaux de Paris (AP-HP), University of Paris VII, Paris, France. 3. Department of Radiology, Institut Bergonié, 229, Cours de l'Argonne, 33000, Bordeaux, France. 4. MSK Imaging Department, Clinique du sport, 2 rue George Negrevergne, 33700, Bordeaux-Mérignac, France. 5. Hernia Center, Clinique du sport, 2 rue George Negrevergne, 33700, Bordeaux-Mérignac, France. 6. MSK Imaging Department, Clinique du sport, 2 rue George Negrevergne, 33700, Bordeaux-Mérignac, France. lionelpesquer@gmail.com.
Abstract
PURPOSE: To compare the insertions of the conjoint tendon (CT) on MRI in athletes with and without symptoms and to assess their relationship to groin pain with surgery as a reference. MATERIALS AND METHODS: Between January and May 2017, patients with inguinal-related groin pain undergoing Shouldice repair were prospectively enrolled and underwent MRI. Exams were independently reviewed by two radiologists blinded to surgical results to assess types of CT insertion as high muscular without (type 1) or with tendinous expansion (type 2) or low muscular (type 3). Radiological and surgical results were compared. Patients were compared with a gender- and age-matched control group of asymptomatic athletes. RESULTS: One hundred twenty-eight walls (64 in patients, 64 in controls) in 64 subjects (32 patients and 32 controls, only men; mean age, 31.7 ± 10 years; range, 15.0-54.8) were analyzed. CT insertion was defined as types 1, 2, and 3 in 32/128 (25%), 35/128 (27%), and 61/128 (48%) walls, respectively, with 22/64 (34%), 27/64 (42%), and 15/64 (23%) in patients and 10/64 (16%), 8/64 (12.5%), and 46/64 (72%) in controls. Type s1+2 were significantly more frequent in patients compared with that in controls (p < 0.01). MRI predicted a high CT insertion with a sensitivity and specificity of 97% (95%CI 85-99) and 62% (95%CI 36-82). The intra- and inter-reader agreement for the prediction of the type of insertion was excellent (k > 0.75). CONCLUSION: A high CT insertion is more frequent in athletes with groin pain and may be a predisposing factor. MRI could help predict the type of CT insertion. KEY POINTS: • MR imaging should be included in the initial workup of patients with inguinal-related groin pain. • MR imaging can be used to visualize the type of insertion with acceptable results. • High insertion of the conjoint tendon may be a predisposing factor for inguinal-related groin pain.
PURPOSE: To compare the insertions of the conjoint tendon (CT) on MRI in athletes with and without symptoms and to assess their relationship to groin pain with surgery as a reference. MATERIALS AND METHODS: Between January and May 2017, patients with inguinal-related groin pain undergoing Shouldice repair were prospectively enrolled and underwent MRI. Exams were independently reviewed by two radiologists blinded to surgical results to assess types of CT insertion as high muscular without (type 1) or with tendinous expansion (type 2) or low muscular (type 3). Radiological and surgical results were compared. Patients were compared with a gender- and age-matched control group of asymptomatic athletes. RESULTS: One hundred twenty-eight walls (64 in patients, 64 in controls) in 64 subjects (32 patients and 32 controls, only men; mean age, 31.7 ± 10 years; range, 15.0-54.8) were analyzed. CT insertion was defined as types 1, 2, and 3 in 32/128 (25%), 35/128 (27%), and 61/128 (48%) walls, respectively, with 22/64 (34%), 27/64 (42%), and 15/64 (23%) in patients and 10/64 (16%), 8/64 (12.5%), and 46/64 (72%) in controls. Type s1+2 were significantly more frequent in patients compared with that in controls (p < 0.01). MRI predicted a high CT insertion with a sensitivity and specificity of 97% (95%CI 85-99) and 62% (95%CI 36-82). The intra- and inter-reader agreement for the prediction of the type of insertion was excellent (k > 0.75). CONCLUSION: A high CT insertion is more frequent in athletes with groin pain and may be a predisposing factor. MRI could help predict the type of CT insertion. KEY POINTS: • MR imaging should be included in the initial workup of patients with inguinal-related groin pain. • MR imaging can be used to visualize the type of insertion with acceptable results. • High insertion of the conjoint tendon may be a predisposing factor for inguinal-related groin pain.
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