title: High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players.
abstract: BACKGROUND
  Prior retrospective studies have reported magnetic resonance imaging (MRI) findings of common adductor-abdominal rectus enthesopathy and acetabular labral tear in athletes treated for athletic pubalgia and hip pain. The true prevalence of these findings and association with symptoms in this population is unknown.
  
  
  OBJECTIVE
  This study was undertaken to determine the prevalence of pelvic and hip MRI findings and association with clinical symptoms in professional and collegiate hockey players.
  
  
  METHODS
  Cross-sectional study; Level of evidence, 3.
  
  
  METHODS
  The study included 21 professional and 18 collegiate hockey players. Self-reported symptoms were measured using a modified Oswestry Disability Questionnaire. Participants underwent 3-T MRI evaluation of the pelvis and hips. The MRI scans were interpreted independently by 3 musculoskeletal radiologists in 2 sessions separated by 3 months using a 5-point Likert scale to assess for features associated with common adductor-abdominal rectus dysfunction and hip pathology. To estimate prevalence, MRI findings rated 4 or higher on 4 of the 6 interpretations were considered positive. A variance component analysis was applied to determine intrareader and interreader reliability and the lower 95% confidence limits (CLs).
  
  
  RESULTS
  No participants reported symptoms related to pelvic or hip disorders. The MRI findings of common adductor-abdominal rectus dysfunction were observed in 14 of 39 participants (36%) and hip pathologic changes in 25 of 39 (64%). There was moderate agreement between readings, with intrareader and interreader reliabilities ranging from 0.37 to 1.00. The interreader reliability was less for evaluation of hip pathologic abnormalities than for groin pathologic abnormalities, with the lowest reliability observed in reporting of hip osteochondral lesions (0.37 with lower 95% CL of 0.22) and fluid in the primary cleft (0.45 with lower 95% CL of 0.29) and perfect reliability in the absence of effusion and abdominal rectus tendon tears. Overall, 30 of 39 (77%) asymptomatic hockey players demonstrated MRI findings of hip or groin pathologic abnormalities.
  
  
  CONCLUSIONS
  Given the high prevalence of MRI findings in asymptomatic hockey players, it is necessary to cautiously interpret the significance of these findings in association with clinical presentation. Future investigations will determine whether these asymptomatic findings predict future disabilities.
authors.affiliation: Pennsylvania State Milton S. Hershey Medical Center, 17033, USA. msilvis@hmc.psu.edu
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Silvis
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Mosher
authors.forename: Brandon S
authors.initials: BS
authors.lastname: Smetana
authors.forename: Vernon M
authors.initials: VM
authors.lastname: Chinchilli
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Flemming
authors.forename: Eric A
authors.initials: EA
authors.lastname: Walker
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Black
mesh_terms: D058070:Asymptomatic Diseases; D003430:Cross-Sectional Studies; D004311:Double-Blind Method; D006615:Hip; D006688:Hockey; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009140:Musculoskeletal Diseases / Q000175:diagnosis*; D010388:Pelvis; D015995:Prevalence; D017568:Rectus Abdominis; D015203:Reproducibility of Results; D014495:Universities; D055815:Young Adult