Endoscopic Pubic Symphysectomy for Athletic Osteitis Pubis

Abstract

Osteitis pubis is a common form of athletic pubalgia associated with femoroacetabular impingement. Endoscopic pubic symphysectomy was developed as a less invasive option than open surgical curettage for recalcitrant osteitis pubis. This technical note demonstrates the use of the anterior and suprapubic portals in the supine lithotomy position for endoscopic burr resection of pubic symphyseal fibrocartilage and hyaline endplates. Key steps include use of the suprapubic portal for burr resection of the posteroinferior symphysis and preservation of the posterior and arcuate ligaments. Endoscopic pubic symphysectomy is a minimally invasive bone-conserving surgery that retains stability and may be useful in the treatment of recalcitrant osteitis pubis or osteoarthritis. It nicely complements arthroscopic surgery for femoroacetabular impingement and may find broader application in this group of co-affected athletes.

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

“…As a complication of surgery, they reported only transient postoperative edema of the scrotum in men and of the labia in women, which resolved within 24 hours in all cases. Similar results have been reported by Matsuda et al43…”

Endoscopic Repair of Proximal Adductor Avulsion

“…Scrotal swelling has been reported in males undergoing endoscopic pubic symphysectomy and endoscopic surgeries for athletic pubalgia but is transient and resolves spontaneously. 6 , 7 , 8 Judicious use of dry endoscopy, low pump pressures (e.g., 40 mm Hg), hypotensive anesthesia, meticulous hemostasis using radiofrequency coagulation, and generous skin incisions (approximately 2 cm) to facilitate fluid egress may minimize soft tissue swelling.…”

“…A 2 cm vertical anterior pubic symphysis (APS) portal 6 and an adductor portal approximately 2 cm distal to the palpated proximal extent of the retracted adductor tendon margin were made. Because the avulsed tendon was not under tension, its location was facilitated by symmetrical palpation of the intact contralateral adductor longus tendon in the lithotomy position.…”

The challenges in diagnosis and management of osteitis pubis: An algorithm based on current evidence

“…Mehin et al 67 after reviewing a case series of 10 patients and review of the literature recommended curettage of the joint for less complex cases and wedge resection in those suspected to have residual infection on curettage after urologic surgery. More recently, endoscopic techniques have been successfully demonstrated in case reports 68,69 …”