Inferior Pubic Ligament Injury: Magnetic Resonance Imaging Assessment in Athletes With Pubic-Related Groin Pain.

Background: Many athletes experience pubalgia. Although much is known about ligament injuries in other joints, the importance of ligament injuries in the pubic joint remains understudied.

Purpose: To determine the frequency of an inferior pubic ligament (IPL) injury on magnetic resonance imaging (MRI) in a population of athletes with isolated pubic-related groin pain and to compare this group with a control group of athletes with adductor-related groin pain to assess the clinical relevance and association of an IPL injury with pubic-related groin pain.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: Inclusion criteria consisted of athletes with pubic-related groin pain. All included participants were given a standardized questionnaire, a clinical examination, and a MRI examination of the pelvis. All MRI scans were reviewed to assess the IPL and other pubic-related pathologies, including pubic bone marrow edema and adductor injuries. The prevalence of an IPL lesion in patients with pubic-related groin pain is reported with the 95% confidence interval (95% CI). A control group with adductor-related groin pain was retrospectively included for comparison. Group characteristics were compared using the Pearson χ² test, Fisher exact test, and Mann-Whitney-Wilcoxon test. Risk factors of IPL injury were analyzed by logistic regression.

Results: A total of 60 athletes were included (56 male, 4 female); 18% showed definite MRI signs of IPL injury. In addition, 15% showed an equivocal IPL abnormality. This resulted in an IPL lesion prevalence of 33% (95% CI, 23%-46%) in this group. Of the 20 athletes with an IPL injury, 18 were soccer players and 2 were track and field athletes. All were men. The median age was 30 years (IQR, 26-36). The risk of IPL lesion was significantly higher in patients with trauma (odds ratio, 8.76; 95% CI, 2.56-29.91; P < .001). No IPL lesions were observed in the control group of 28 athletes with adductor-related groin pain (P < .001).

Conclusion: On the basis of MRI analysis, there is a relatively high frequency of IPL injuries (33%) in athletes with pubic-related groin pain in addition to pubic bone and adductor pathology. No IPL injuries (0%) were observed in a control group of athletes with adductor-related groin pain. Our findings support the consideration of IPL injury in the diagnostic workup of pubic-related groin pain, particularly in posttraumatic cases. Further research is needed to refine the diagnostic process and to better understand the implications of IPL injury for rehabilitation and return-to-play outcomes.