Rectus abdominus-adductor longus aponeurosis tear - superior cleft sign
Presentation
Ongoing medial groin pain.
Patient Data
Left superior cleft sign, with a fluid cleft partially extending between the aponeurotic-bone interface of the combined rectus abdominus-adductor longus aponeurosis, anterior to the left superior pubic ramus. Small amount of adjacent marrow edema, without fracture. Small amount of left-sided subchondral fatty change at the pubic symphysis, without associated significant osteoarthritis.
Case Discussion
Both the superior cleft and secondary cleft signs, signify partial avulsion tears of the rectus abdominus-adductor longus aponeurosis 1. Specific MRI protocols have been developed to better assess those with 'athletic pubalgia', and sequences include axial oblique fluid sensitive sequences through the pubic symphysis and aponeurosis to better clarify the extent of these tears. In complete tears, there will be retraction.
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