Secondary Cleft Sign

The "primary" pubic symphyseal cleft is a midline physiologic space that develops in the fibrocartilage of the pubic symphysis in maturity. The secondary cleft is the pathologic extension of this space inferolaterally and has been suggested as a marker of injury in athletes with groin pain (athletic pubalgia). It is thought to represent a defect in the rectus abdominis tendon insertion that extends into the adductor tendon origins.

The sign may be seen during fluoroscopic arthrography or on fluid-sensitive sequences at MR. In one study, it was seen in approximately 50% of patients who were referred to a subspecialty surgeon for groin pain. Its sensitivity and specificity as an indicator of rectus abdominis muscle injury were 57% and 60%, respectively.

References

• Brennan D, et al. Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology. 2005 Apr;235(1):162-7.
• Zoga AC, et al. Athletic pubalgia and the "sports hernia": MR imaging findings. Radiology. 2008 Jun;247(3):797-807.