Thank you for those who answered my e-mail on MRI of the pubic symphysis. Answers that I got on my case included:
I would call a high grade partial Add Longus tear on the left, the Rectus Abd aponeurosis is intact.
The Right Add longus looks previously strained and healed, I think.
He’s also got that degenerative posterior protrusion of the articular disc that John Read talks about
I would call that a chronic nondisplaced tear of the bilateral adductor plate, left more than right. I think there is a definite secondary cleft sign on the left. The right isn’t as clear of a secondary cleft, but the signal is pretty high at the interface between the adductor plate and bone. Usually the adductor plate is very dark at the bone interface.
Just osteitis pubis and grade 1 strain of adductor – pulling of sharpey fibers . Non surgical case. Look for early atrophy of lat head of rectus to call any sort of classic athletic pubalgia.
In a skeletally immature kid like this, I think that the weak point in the pubic plate is often the unfused pubic apophyses. There MUST be instability at the symphysis to create that much OP, and the plates do not look detached off midline, so I’d call this a midline core muscle injury centered at a skeletally immature pubic symphysis. Problem is, in my experience, once kids like this are injured, the apophyses never fuse. If it were my kid I’d consider some aggressive needling of the plate & apophyses with anesthetic to try to stimulate fusion followed by core muscle injury PT. My colleague would most certainly operate. PRP seems reasonable but we keep seeing formation of heterotopic ossification when we use it in kids like this.
As someone who suffered from this and could not get back on the pitch until after undergoing surgery, I have a low threshold to call this. My case (similar to this) had mild increase signal/cleft sign and was finally called by the group in Philly after bouncing around from different orthopods and multiple repeat hip/pelvis imaging. Years of rehab and rest with no improvement. After surgery, was able to play again and at a high level.
I really appreciate the input!
Kate
