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Pubic Magnetic Resonance Imaging Findings in Surgically and Conservatively Treated Athletes With Osteitis Pubis Compared to Asymptomatic Athletes During Heavy Training

Hannu Paajanen, MD, PhD^,*, Heikki Hermunen, MD and Jari Karonen, MD

From the Department of Surgery and the Department of Radiology, Central Hospital of Mikkeli, Mikkeli, Finland

^* Address correspondence to Hannu Paajanen, MD, PhD, Department of General Surgery, Central Hospital of Mikkeli, 50100 Mikkeli, Finland (e-mail: hannu.paajanen{at}esshp.fi).

Background: Osteitis pubis is characterized by diffuse pain, inflammation, and bony changes in the pubic symphysis. Bone marrow edema in magnetic resonance imaging is associated with stress injury and osteitis of the pubic bone.

Hypothesis: Laparoscopic mesh repair decreases inflammation and pain in the pubic periosteum. The presence of extensive bone marrow edema may correlate with the severity of symptoms and may guide the surgical treatment of osteitis pubis.

Study Design: Case control study; Level of evidence, 4.

Methods: Surgery (n = 8) was performed by placement of totally extraperitoneal endoscopic mesh behind the symphysis. Nonoperative treatment (n = 8) included physical therapy and corticosteroids. Preoperative and postoperative pain was measured by the visual analog scale. Athletes were followed up from 1 to 6 years (mean, 2.7 years). All magnetic resonance imaging scans were analyzed blindly by 2 radiologists. Twenty asymptomatic ice hockey or soccer players served as controls in magnetic resonance imaging.

Results: The patients treated surgically had higher preoperative pain scores than did the patients treated conservatively. Seven of 8 athletes (88%) treated surgically returned to sport activities after 2 months of convalescence. No complications were associated with surgery. In the nonoperative group, 4 patients (50%) still had disabling symptoms after 1 year of follow-up, and they stopped their elite sports during 3 years of follow-up. The presence of bone marrow edema was distributed in the surgical (100%), nonoperative (88%), and asymptomatic athletes (65%) with no statistical difference between the groups.

Conclusion: This study indicated that the placement of retropubic mesh was an efficient method for the treatment of severe pubic enthesopathy in athletes. Abnormal magnetic resonance imaging findings were also common in asymptomatic athletes, which decreases the value of magnetic resonance imaging in surgical decision-making.

Key Words: groin pain • osteitis pubis • pubalgia • magnetic resonance imaging (MRI) • laparoscopic repair