OSTEITIS PUBIS

Introduction: Osteitis pubis is the inflammation of the symphysis pubis joint. It is one of the most chronic and debilitating syndromes affecting athletes. Patients refer with groin pain and differential diagnosis may be cumbersome. The study was planned to determine the correlation of MR findings with clinical properties and to see if the disease itself was responsible for the symptoms in chronic cases.

Material & Methods: Patients who had referred to the sports medicine clinic with groin pain and received a possible diagnosis of osteitis pubis were included in the study. Pelvic MR images of the 22 cases meeting these criteria were taken. Correlation analysis between the MR findings and clinical properties such as duration of symptoms, severity of the disease, and length of sports life was carried out.

Results: Six of the MR findings had strong correlation with duration of symptoms. Subchondral bone marrow edema (p=0.000), fluid in symphysis pubis joint (p=0.000), and periarticular edema (p=0.006) had statistically significant correlation with acuity of the case. On the contrary subchondral sclerosis (p=0.006), subchondral erosions and bony margin irregularities (p=0.002), and osteophytes (p=0.000) had statistically significant correlation with chronicity of the case. Associated tendon injuries did have significant correlation (P=0.027) with the duration of symptoms; i.e. all tendon injuries were in chronic cases.

Conclusion: Subchondral bone marrow edema, fluid in symphysis pubis joint, and periarticular edema are the most reliable MRI findings of osteitis pubis that has a history of less than 6 months. Subchondral sclerosis, subchondral erosions and bony margin irregularities, and osteophytes (or pubic beaking) are the most reliable MRI findings of the chronic disease which had been present for more than 6 months. Associated pathologies, especially adductor or other tendon injuries, underlie more than half of the chronic cases of osteitis pubis.