Osteitis pubis in elite athletes: Diagnostic and therapeutic approach

Abstract

Osteitis pubis (OP) is a debilitating overuse syndrome characterizing by pelvic pain and local tenderness over the pubic symphysis commonly encountered in athletes often involved in kicking, twisting and cutting activities in sports such as soccer and rugby and to a lesser degree distance running. It is a common source of groin pain in elite athletes attributable to pubis sympysis instability as the result of microtrauma caused by repetitive muscle strains on pubic bones. Diagnosis is based mainly on detailed sports history and a meticulous clinical examination, although occasionally is difficult to distinguish this nosological entity from other pathologies affecting the involved area which may occur concomitantly in the same patient. Radiologic examinations such as plain radiographs, magnetic resonance imaging and 3 phase bone isotope scanning may be helpful to differentiate from other clinical entities with similar clinical presentation. Most cases respond well to conservative treatment which includes several physical modalities and especially a progressive rehabilitation programmed individualized to each one of patients diagnosed with OP. Local injection therapies have been also been proposed as a non-operative therapeutic option for the efficient management of these patients. In refractory cases, surgical therapeutic strategies are warranted. These include several open or minimally invasive surgical interventions such as arthroscopic or open symphysis curettage, wedge or total resection of pubic sympysis, polypropylene mesh placement and pubic fusion. In this review a critical analysis of OP in elite athletes is performed with special focus on current concepts of diagnosis and management of this source of athletic groin pain.

Management of osteitis pubis in athletes: rehabilitation and return to training – a review of the most recent literature

“…Many different open or minimally invasive surgical procedures have been proposed, including open or endoscopic curettage of the symphysis pubis, arthrodesis of the symphysis with or without bone graft and wedge resection 38. All procedures can be associated with the release of the adductor tendons or with adductor enthesis repair 2,39–41. These surgical treatments vary widely in their invasiveness, impact on pelvic biomechanics and recovery time.…”

“…It commonly affects athletes, especially those who participate in sports that involve kicking, turning, twisting, cutting, pivoting, sprinting, rapid acceleration and deceleration or sudden directional changes 1. Osteitis pubis has been described in athletes who play sports such as soccer, rugby, ice hockey, Australian Rules football and distance running 2…”

Postpartum Septic Symphysitis, a Rare Condition With Possible Long-Term Consequences: A Cohort Study With Long-Term Follow-Up

“…In the literature, several conditions causing pain around the symphysis have been described. In ammatory conditions such as osteitis pubis [12] and postpartum pubic symphysis diastasis [1,13] must be distinguished from infectious complications such as PPSS. Some conditions similar to PPSS are osteomyelitis of the pubic symphysis [1,6], septic arthritis of the symphysis (also called pubic osteomyelitis, osteomyelitis of the pubic bone or pubic symphysis), and rare orthopaedic infections, accounting for less than 1-2% of all haematogenous osteomyelitis.…”

Do Pain and Function Improve after Dextrose Prolotherapy or Autologous Platelet-Rich Plasma Injection in Longstanding Groin Pain?

“…Longstanding groin pain is a non-infectious and inflammatory chronic condition that affects symphysis pubis and surrounding tissues (Jardí et al, 2014). It is an overuse injury of the groin area in athletes participating in strenuous athletic activities, especially among soccer players (Angoules, 2015). Kicking, turning, twisting, cutting, pivoting, and sprinting activities associated with sports such as soccer, rugby, gridiron football, ice hockey, Australian rules football, and distance running have been linked to this pathology (Angoules, 2015;Jardí et al, 2014).…”

“…It is an overuse injury of the groin area in athletes participating in strenuous athletic activities, especially among soccer players (Angoules, 2015). Kicking, turning, twisting, cutting, pivoting, and sprinting activities associated with sports such as soccer, rugby, gridiron football, ice hockey, Australian rules football, and distance running have been linked to this pathology (Angoules, 2015;Jardí et al, 2014). The incidence rate of groin pain is estimated at 10% to 18% per year among male soccer players (Hölmich et al, 1999).…”