Osteitis pubis remains a relatively unfamiliar area of orthopaedics and sports medicine. This condition occurs in high-level athletes and particularly in footballers. It is a rather painful condition that is associated with increased levels of physical activity and causes persistent, long-lasting symptoms.
Many views have been put forward on the pathophysiology of osteitis pubis, which certainly has mechanical features. Recently the mechanical relationship between the hip joint and the pubic symphysis appears to be prevailing, that is, the indirect provocation of osteitis pubis by problems of the hip and particularly by femoroacetabular impingement syndrome.
A new study attempts to shed light on this unfamiliar field by analysing the relationship between femoroacetabular impingement and osteitis pubis in symptomatic football players. The study included patients who presented with pain at the pubic symphysis or bone oedema on MRI around it.
In all, 577 consecutive patients were included who underwent hip arthroscopy for the correction of femoroacetabular impingement syndrome. The patients were studied retrospectively with a minimum follow-up of two years. High-level footballers were included, both professional and non-professional. The authors assessed the hip outcome scores Modified Harris Hip Score and Nonarthritic Hip Score preoperatively, at six months, one year and two years postoperatively. The patients were also divided into two groups according to the radiographic findings, those with typical findings of osteitis pubis and those with bone oedema around the pubic symphysis. The clinical outcome, the return to football and the radiographic findings were assessed. 28 hips met the criteria for inclusion in the study. Both the Modified Harris Hip Score and the Nonarthritic Hip Score showed a statistically significant improvement after hip arthroscopy. In addition, 92% of the athletes returned to football at the same or a higher level at a median of 5.5 months (range 4 to 15 months). 67.8% had a radiographic appearance of osteitis pubis and 35.7% had bone oedema around the pubic symphysis. The alpha angle was significantly higher in the group with bone oedema than in the group without bone oedema. There was a significant difference in tenderness of the pubic symphysis, from 32.1% preoperatively to 3.6% postoperatively. In addition, the findings of bone oedema around the pubic symphysis on MRI disappeared in all the players over a period with a median of 11 months after the surgical procedure.
The authors concluded that arthroscopic treatment of femoroacetabular impingement provides a favourable clinical outcome and a high rate of return to sporting activity in professional, high-level footballers suffering from osteitis pubis.
Source: “The American Journal of Sports Medicine”, January 2019