Skip to main content
SpringerLink
Log in

Reliability of MRI assessment of acute musculotendinous groin injuries in athletes

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To describe a multi-dimensional MRI assessment approach with a focus on acute musculotendinous groin lesions, and to evaluate scoring reproducibility.

Methods

Male athletes who participated in competitive sports and presented within 7 days of an acute onset of sports-related groin pain were included. All athletes underwent MRI (1.5 T) according to a standardized groin-centred protocol. From several calibration sessions, a system was developed assessing grade, location and extent of muscle strains, peri-lesional haematoma, as well as other non-acute findings commonly associated with long-standing groin pain. Kappa (K) statistics and intraclass correlation coefficients (ICCs) were used to describe intra- and inter-rater reproducibility.

Results

Seventy-five athletes (mean age 26.6 ± 4.4 years) were included in the analyses, and 85 different acute lesions were observed. Adductor longus lesions were most common (42.7 %) followed by rectus femoris lesions (16.3 %). Kappa values ranged between 0.70 and 1.00 for almost all categorical features for acute lesions, with almost perfect intra- and inter-rater agreement (K = 0.89-1.00) for presence, number, location and grading of lesions. ICCs ranged between 0.77 and 1.00 for continuous measures of acute lesion extent.

Conclusions

A standardized MRI assessment approach of acute groin injuries was described and showed good intra- and inter-rater reproducibility.

Key Points

• A multidimensional MRI assessment approach for acute groin injuries was described.

• Standardized MRI assessment of acute musculotendinous groin injuries has high reproducibility.

• Injury location and injury extent can be scored reliably using 1.5 T MRI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

CSA:

Cross-sectional area

FOV:

Field of view

ICC:

Intraclass correlation coefficient

IRB:

Institutional Review Board

MRI:

Magnetic resonance imaging

MSK:

Musculoskeletal

TE:

Echo time

TR:

Repetition time

References

  1. Walden M, Hagglund M, Ekstrand J (2015) The epidemiology of groin injury in senior football: a systematic review of prospective studies. Br J Sports Med 49:792–797

    Article  PubMed  Google Scholar 

  2. Hägglund M, Waldén M, Ekstrand J (2005) Injury incidence and distribution in elite football--a prospective study of the Danish and the Swedish top divisions. Scand J Med Sci Sports 15:21–28

    Article  PubMed  Google Scholar 

  3. Renström P, Peterson L (1980) Groin injuries in athletes. Br J Sports Med 14:30

    Article  PubMed  PubMed Central  Google Scholar 

  4. Werner J, Hägglund M, Waldén M, Ekstrand J (2009) UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 43:1036–1040

    Article  CAS  PubMed  Google Scholar 

  5. Branci S, Thorborg K, Nielsen MB, Hölmich P (2013) Radiological findings in symphyseal and adductor-related groin pain in athletes: a critical review of the literature. Br J Sports Med. doi:10.1136/bjsports-2012-091905

    Google Scholar 

  6. Branci S, Thorborg K, Bech BH, et al (2014) The Copenhagen Standardised MRI protocol to assess the pubic symphysis and adductor regions of athletes: outline and intratester and intertester reliability. Br J Sports Med bjsports-2014-094239. doi:10.1136/bjsports-2014-094239

  7. Ekstrand J, Hilding J (1999) The incidence and differential diagnosis of acute groin injuries in male soccer players. Scand J Med Sci Sports 9:98–103

    Article  CAS  PubMed  Google Scholar 

  8. Serner A, Tol JL, Jomaah N, et al (2015) Diagnosis of acute groin injuries a prospective study of 110 athletes. Am J Sports Med 363546515585123. doi:10.1177/0363546515585123

  9. Weir A, Brukner P, Delahunt E et al (2015) Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 49:768–774

    Article  PubMed  PubMed Central  Google Scholar 

  10. Coker DJ, Zoga AC (2015) The role of magnetic resonance imaging in athletic pubalgia and core muscle injury. Top Magn Reson Imaging 24:183–191

    Article  PubMed  Google Scholar 

  11. Hancock CR, Sanders TG, Zlatkin MB et al (2009) Flexor femoris muscle complex: grading systems used to describe the complete spectrum of injury. Clin Imaging 33:130–135

    Article  PubMed  Google Scholar 

  12. Peetrons P (2002) Ultrasound of muscles. Eur Radiol 12:35–43

    Article  CAS  PubMed  Google Scholar 

  13. Lube J, Cotofana S, Bechmann I et al (2015) Reference data on muscle volumes of healthy human pelvis and lower extremity muscles: an in vivo magnetic resonance imaging feasibility study. Surg Radiol Anat SRA. doi:10.1007/s00276-015-1526-4

    PubMed  Google Scholar 

  14. Comin J, Malliaras P, Baquie P et al (2013) Return to competitive play after hamstring injuries involving disruption of the central tendon. Am J Sports Med 41:111–115

    Article  PubMed  Google Scholar 

  15. Murphy G, Foran P, Murphy D et al (2013) “Superior cleft sign” as a marker of rectus abdominus/adductor longus tear in patients with suspected sportsman’s hernia. Skeletal Radiol 42:819–825

    Article  PubMed  Google Scholar 

  16. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  17. Hallén A, Ekstrand J (2014) Return to play following muscle injuries in professional footballers. J Sports Sci 1–8. doi:10.1080/02640414.2014.905695

  18. Schneider-Kolsky ME, Hoving JL, Warren P, Connell DA (2006) A comparison between clinical assessment and magnetic resonance imaging of acute hamstring injuries. Am J Sports Med 34:1008–1015

    Article  PubMed  Google Scholar 

  19. Slavotinek JP, Verrall GM, Fon GT (2002) Hamstring injury in athletes: using MR imaging measurements to compare extent of muscle injury with amount of time lost from competition. AJR Am J Roentgenol 179:1621–1628

    Article  PubMed  Google Scholar 

  20. Cermak NM, Noseworthy MD, Bourgeois JM et al (2012) Diffusion tensor MRI to assess skeletal muscle disruption following eccentric exercise. Muscle Nerve 46:42–50

    Article  PubMed  Google Scholar 

  21. Guermazi A, Roemer FW (2015) Compositional MRI assessment of cartilage: what is it and what is its potential for sports medicine? Br J Sports Med. doi:10.1136/bjsports-2015-095146

    Google Scholar 

  22. Larsen RG, Ringgaard S, Overgaard K (2007) Localization and quantification of muscle damage by magnetic resonance imaging following step exercise in young women. Scand J Med Sci Sports 17:76–83

    CAS  PubMed  Google Scholar 

  23. Hamilton B, Whiteley R, Almusa E et al (2014) Excellent reliability for MRI grading and prognostic parameters in acute hamstring injuries. Br J Sports Med 48:1385–1387

    Article  CAS  PubMed  Google Scholar 

  24. Wangensteen A, Almusa E, Boukarroum S, et al (2015) MRI does not add value over and above patient history and clinical examination in predicting time to return to sport after acute hamstring injuries: a prospective cohort of 180 male athletes. Br J Sports Med bjsports-2015–094892. doi:10.1136/bjsports-2015-094892

  25. Reurink G, Goudswaard GJ, Tol JL et al (2013) MRI observations at return to play of clinically recovered hamstring injuries. Br J Sports Med. doi:10.1136/bjsports-2013-092450

    PubMed  PubMed Central  Google Scholar 

  26. Branci S, Thorborg K, Bech BH et al (2014) MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls. Br J Sports Med. doi:10.1136/bjsports-2014-093710

    Google Scholar 

  27. Hunter DJ, Guermazi A, Lo GH et al (2011) Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score). Osteoarthr Cartil OARS Osteoarthr Res Soc 19:990–1002

    Article  CAS  Google Scholar 

  28. Crema MD, Guermazi A, Tol JL et al (2015) Acute hamstring injury in football players: association between anatomical location and extent of injury-A large single-center MRI report. J Sci Med Sport Sports Med Aust. doi:10.1016/j.jsams.2015.04.005

    Google Scholar 

  29. Peh WC, Chan JH (2001) Artifacts in musculoskeletal magnetic resonance imaging: identification and correction. Skeletal Radiol 30:179–191

    Article  CAS  PubMed  Google Scholar 

  30. Roemer FW, Guermazi A (2015) What is the role of 3 T MRI in sports medicine? Revisiting the marriage after the honeymoon. Br J Sports Med bjsports-2015-095139. doi:10.1136/bjsports-2015-095139

Download references

Acknowledgements

The scientific guarantor of this publication is Andreas Serner. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding.

Outside this work, Dr. Guermazi has received consultancies, speaking fees and/or honoraria from Sanofi-Aventis, Merck Serono and TissuGene and is President and shareholder of Boston Imaging Core Lab (BICL), LLC a company providing image assessment services. Dr. Roemer is Chief Medical Officer and shareholder of BICL, LLC. None of the other authors have declared any competing interests. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study.

Some study subjects or cohorts have been previously reported in: Serner A, Tol JL, Jomaah N, et al. (2015) Diagnosis of Acute Groin Injuries: A Prospective Study of 110 Athletes. Am J Sports Med 0363546515585123. doi: 10.1177/0363546515585123. Methodology: prospective, cross-sectional study, performed at one institution.

Author information

Author notes

    Authors and Affiliations

    1. Aspetar, Orthopaedic and Sports Medicine Hospital, Sports City Street, P.O. Box 29222, Doha, Qatar

      Andreas Serner, Per Hölmich, Adam Weir & Johannes L. Tol

    2. Sports Orthopaedic Research Center–Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark

      Andreas Serner, Per Hölmich & Kristian Thorborg

    3. Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany

      Frank W. Roemer

    4. Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA

      Frank W. Roemer & Ali Guermazi

    5. Clinical Epidemiology and Training Unit, Department of Medicine, Boston University School of Medicine, Boston, MA, USA

      Jingbo Niu

    6. The Sports Physician Group, Department of Sports Medicine, OLVG West, Amsterdam, The Netherlands

      Johannes L. Tol

    7. Amsterdam Center of Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, The Netherlands

      Johannes L. Tol

    Authors
    1. Andreas Serner
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Frank W. Roemer
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Per Hölmich
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Kristian Thorborg
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Jingbo Niu
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Adam Weir
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Johannes L. Tol
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Ali Guermazi
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Andreas Serner.

    Additional information

    Andreas Serner and Frank W. Roemer contributed equally to this work.

    Electronic supplementary material

    Below is the link to the electronic supplementary material.

    ESM 1

    (DOC 41 kb)

    ESM 2

    (DOCX 25 kb)

    ESM 3

    (DOCX 163 kb)

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Serner, A., Roemer, F.W., Hölmich, P. et al. Reliability of MRI assessment of acute musculotendinous groin injuries in athletes. Eur Radiol 27, 1486–1495 (2017). https://doi.org/10.1007/s00330-016-4487-z

    Download citation

    • Received:

    • Revised:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00330-016-4487-z

    Keywords

    Search

    Navigation