Cleft Sign in MRI May Represent the Disruption of Cartilage Structure within Pubic Symphysis and Pubic Plate: A Cadaver Case Report
Haruki Nishimura,
Xueqin Gao,
Sadao Niga,
Naomasa Fukase,
Yoichi Murata,
Patrick M. Quinn,
Masayoshi Saito,
Hajime Utsunomiya,
Soshi Uchida,
Johnny Huard,
Marc J. Philippon
Affiliations
Haruki Nishimura
The Linda & Mitch Hart Center for Regenerative and Personalized Medicine, Steadman Philippon Research Institute, 181 West Meadow Dr., Suite 1000, Vail, CO 81657, USA
Xueqin Gao
The Linda & Mitch Hart Center for Regenerative and Personalized Medicine, Steadman Philippon Research Institute, 181 West Meadow Dr., Suite 1000, Vail, CO 81657, USA
Sadao Niga
JIN Orthopaedic & Sports Clinic, 3-10-7 Suzuya, Chuo-ku, Saitama-city 338-0013, Saitama, Japan
Naomasa Fukase
Department of Orthopaedic Surgery, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe-city 650-0017, Hyogo, Japan
Yoichi Murata
Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu, Kitakyushu-city 808-1264, Fukuoka, Japan
Patrick M. Quinn
The Linda & Mitch Hart Center for Regenerative and Personalized Medicine, Steadman Philippon Research Institute, 181 West Meadow Dr., Suite 1000, Vail, CO 81657, USA
Masayoshi Saito
Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashibaru, Mito-city 310-0035, Ibaraki, Japan
Hajime Utsunomiya
Tokyo Sports & Orthopaedic Clinic, 4-29-9 Kamiikebukuro, Toyoshima-ku, Tokyo 170-0012, Japan
Soshi Uchida
Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu, Kitakyushu-city 808-1264, Fukuoka, Japan
Johnny Huard
The Linda & Mitch Hart Center for Regenerative and Personalized Medicine, Steadman Philippon Research Institute, 181 West Meadow Dr., Suite 1000, Vail, CO 81657, USA
Marc J. Philippon
The Linda & Mitch Hart Center for Regenerative and Personalized Medicine, Steadman Philippon Research Institute, 181 West Meadow Dr., Suite 1000, Vail, CO 81657, USA
Background/Objectives: Long-standing groin pain is a severe issue for athletes, often associated with the cleft sign on magnetic resonance imaging (MRI) scans, yet its underlying causes are poorly understood. The purpose of this study is to histologically examine the pubic plate structure in cadavers with and without the cleft sign on MRI, shedding light on the pathology behind the cleft sign. Methods: Three fresh human pelvic cadavers underwent 3.0T MRI to detect the cleft sign before histological dissection of pubic plates. Pubic plate tissues were fixed in formalin, decalcified, and processed. Of the two cleft sign-negative specimens, one was cut into sagittal sections, and the other was cut into coronal sections for histology. For the cleft sign positive specimen, a sagittal section was cut. Moreover, 5 µm thick sections were cut at different axial levels for each orientation. Sections were subjected to Safranin O, Alcian blue, and Herovici’s staining or hematoxylin and eosin staining. Results: MRI confirmed that one specimen had a cleft sign in the inferior region on both sides of the pubis and that two specimens had no cleft sign. Both sagittal and coronal sections showed the presence of a cartilage structure continuing from the pubic symphysis to 3 mm laterally within the pubic plate. In the specimen with a positive cleft sign, cartilage damage within the pubic symphysis and pubic plate was identified as revealed by Safranin O staining, Herovici’s staining, and H&E staining. Conclusions: This study elucidated the existence of a cartilage component extending from the pubic symphysis to the pubic plate. The cleft sign in MRI correlated with a disruption in the cartilage component in histology within this specific area.
