Radiographic assessment of the pubic symphysis in elite male adolescent football players:Development and reliability of the Maturing Adolescent Pubic Symphysis (MAPS) classification

Introduction: The pubic symphysis is susceptible to growth related injuries long after the adolescent growth spurt. Our study describes the radiographic maturation of the pubic symphysis on pelvic radiographs in adolescent football players and introduces the Maturing Adolescent Pubic Symphysis classification (MAPS classification). Methods: Anteroposterior pelvic radiographs of 105 healthy adolescent male football players between 12 and 24 years old were used to develop the classification system. The radiological scoring of the symphyseal joint was developed over five rounds. The final MAPS classification items were scored in random order by two experienced readers, blinded to the age of the participant and to each other's scoring. The inter- and intra-rater reliability were examined using weighted kappa (κ). Results: We developed a classification system with descriptive definitions and an accompanying pictorial atlas. The symphyseal joint was divided into three regions: the superior corners, and the upper and lower regions of the joint line. Inter-rater reliability was substantial to almost perfect: superior region: κ = 0.70 (95% CI 0.60–––0.79), upper region of the joint line: κ = 0.89 (95% CI 0.86–––0.92), lower region of the joint line: κ = 0.65 (95% CI 0.55–––0.75). The intra-observer reliability showed similar results. Conclusion: The Maturing Adolescent Pubic Symphysis classification (MAPS classification) is a reliable descriptive classification of the radiographic maturation of the pubic symphysis joint in athletic males. The stages can provide a basis for understanding in clinical practice and will allow future research in this field.</p

Parturition mode recommendation and symptoms of pelvic floor disorders after obstetric anal sphincter injuries

Introduction and hypothesis: Our primary objective was to evaluate parturition mode (PM) recommendations following obstetric anal sphincter injuries (OASIs) and adherence to these recommendations and to evaluate recurrence of OASIs in women who had a subsequent vaginal delivery (VD). The hypothesis was that adherence to the PM recommendations leads to a reasonable OASI recurrence rate. Methods: This was a retrospective observational cohort study of patients with previous OASIs between 2010 and 2016. After an outpatient visit including 3D transperineal ultrasound to screen for pelvic floor and anal sphincter injuries, all patients received recommendations for a subsequent PM. Patients were invited to complete validated questionnaires 2 to 5 years post-OASIs. Results: The majority of invited patients (265/320) attended follow-up, with 264 receiving a recommendation for PM. Only 5.6% did not adhere to the received recommendation. One hundred sixty-one patients delivered again, 58% had a VD, and 42% had a cesarean section (CS). Recurrence of OASIs was observed in 4.3% of the patients that had a VD. Fecal incontinence occurred in 4.9%, however any form of anal incontinence in 48% of patients. While dyspareunia was common in patients with residual external anal sphincter (EAS) injuries and levator ani muscle (LAM) avulsions, anal pain occurred more frequently in EAS injuries and fecal incontinence in LAM avulsions. Conclusions: This study showed that the vast majority of patients followed PM recommendations, and this resulted in a low recurrence of OASIs with a high CS rate. Fecal incontinence after OASIs was correlated with the degree of OASIs