Patterns of Bone and Soft-Tissue Injury at the Symphysis Pubis in Soccer Players: Observations at MRI

Abstract

In soccer players with pubalgia, adductor dysfunction is a more frequent MRI finding than osteitis pubis. The findings of this study suggest that both entities are mechanically related and that osteitis pubis and adductor dysfunction frequently coexist but, because adductor dysfunction is commonly identified in the absence of osteitis, that adductor dysfunction most likely precedes the development of osteitis pubis in soccer players. The presence of edema on fat-suppressed images of the symphysis is a strong predictor of abnormality at this site in soccer players when compared with age- and sex-matched control subjects.

Proposed Algorithm for the Management of Athletes With Athletic Pubalgia (Sports Hernia): A Case Series

“…Surgical exploration of patients with athletic pubalgia indicates that a small percentage of patients have a small direct or indirect hernia in combination with a sports hernia. 23,39,43,52,80 Adductor involvement is common in patients with athletic pubalgia, 4,20,21,37,71 and 3 of the 6 patients in this case series presented with a physician diagnosis and/or imaging confirmation of an adductor strain. The finding that adductor pain often improves after sports hernia repair suggests that adductor tendonitis may be a secondary phenomenon to the initial injury.…”

“…21,51,63,75 In addition, sport-specific activities involving repetitive unilateral-extremitydominant jumping and side-to-side motion may eventually result in muscle strength imbalances and pelvic malalignment. 1,20,23,49,80 The patients in this case series did present with muscular imbalances, including unilateral and/ or bilateral hip flexor shortening, limited mobility of the hip anterior capsule, and limited hip external rotation range of motion. If athletes lack sufficient hip extension, they may compensate with excessive lumbar spine extension, which may, over time, lead to microscopic tearing of the lower abdominal musculature.…”

“…58 Osteitis pubis is another diagnosis presenting very similar to an adductor strain and sports hernia. 4,20,21,37 These 3 pathologies can occur simultaneously, as the symphysis pubis is supported by the rectus abdominis and adductor longus aponeurosis. 20 Authors report patients with confirmed osteitis pubis failing to respond to conservative treatment often have successful outcomes after a sports hernia repair, 22,59 suggesting that osteitis pubis can coexist with a sports hernia and surgery may be beneficial for complete resolution of symptoms.…”

Presence of Inguinal Hernia in Soccer Players with Osteitis Pubis

“…Osteitis pubis futbolcularda sık görülen bir kasık ağrısı nedenidir (5,8). Aşırı ve zorlayıcı atletik yüklenmenin simfizis pubis ve parasimfizeal kemiklerde meydana getirdiği stres reaksiyonuna bağlı olarak gelişir.…”

“…Lovell 189 kronik kasık ağrılı sporcu üzerinde yaptığı çalışmada osteitis pubisli 26 olgu bildirmiş ve bu olguların %46'sında ikinci bir kasık patolojisinin varlığına (çoğunlukla adduktor lezyonu) işaret etmiştir (7). Futbolcular üzerindeki araştırmalarda da, osteitis pubisli olguların sıklıkla adduktor tendon yaralanmasına sahip oldukları bildirilmiştir (5,8). Benzer bir sonuç bu çalışmada da ortaya çıktı ve osteitis pubisli futbolcuların %62'sinde adduktor lezyonları saptandı.…”