Pubic apophysitis: a previously undescribed clinical entity of groin pain in athletes

TY - JOUR

T1 - Pubic apophysitis

T2 - a previously undescribed clinical entity of groin pain in athletes

AU - Sailly, Matthieu

AU - Whiteley, Rod

AU - Read, John W

AU - Giuffre, Bruno

AU - Johnson, Amanda

AU - Hölmich, Per

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - BACKGROUND: Sport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on adolescents. Cadaveric and imaging studies identify a secondary ossification centre located along the anteromedial corner of pubis beneath the insertions of symphysial joint capsule and adductor longus tendon. Little is known about this apophysis and its response to chronic stress.AIM: We report pubic apophysitis as a clinically relevant entity in adolescent athletes.METHODS: The clinical and imaging findings in 26 highly trained adolescent football players (15.6 years ± 1.3) who complained of adductor-related groin pain were reviewed. The imaging features (X-ray 26/26, US 9/26, MRI 11/26, CT 7/26) of the pubic apophyses in this symptomatic group were compared against those of a comparison group of 31 male patients (age range 9-30 years) with no known history of groin pain or pelvic trauma, who underwent pelvic CT scans for unrelated medical reasons.RESULTS: All symptomatic subjects presented with similar history and physical findings. The CT scans of these patients demonstrated open pubic apophyses with stress-related physeal changes (widening, asymmetry and small rounded cyst-like expansions) that were not observed in the comparison group. No comparison subject demonstrated apophyseal maturity before 21 years of age, and immaturity was seen up to the age of 26 years.CONCLUSIONS: This retrospective case series identifies pubic apophyseal stress (or 'apophysitis') as an important differential consideration in the adolescent athlete who presents with groin pain.

AB - BACKGROUND: Sport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on adolescents. Cadaveric and imaging studies identify a secondary ossification centre located along the anteromedial corner of pubis beneath the insertions of symphysial joint capsule and adductor longus tendon. Little is known about this apophysis and its response to chronic stress.AIM: We report pubic apophysitis as a clinically relevant entity in adolescent athletes.METHODS: The clinical and imaging findings in 26 highly trained adolescent football players (15.6 years ± 1.3) who complained of adductor-related groin pain were reviewed. The imaging features (X-ray 26/26, US 9/26, MRI 11/26, CT 7/26) of the pubic apophyses in this symptomatic group were compared against those of a comparison group of 31 male patients (age range 9-30 years) with no known history of groin pain or pelvic trauma, who underwent pelvic CT scans for unrelated medical reasons.RESULTS: All symptomatic subjects presented with similar history and physical findings. The CT scans of these patients demonstrated open pubic apophyses with stress-related physeal changes (widening, asymmetry and small rounded cyst-like expansions) that were not observed in the comparison group. No comparison subject demonstrated apophyseal maturity before 21 years of age, and immaturity was seen up to the age of 26 years.CONCLUSIONS: This retrospective case series identifies pubic apophyseal stress (or 'apophysitis') as an important differential consideration in the adolescent athlete who presents with groin pain.

KW - Abdominal Pain

KW - Adolescent

KW - Arthritis

KW - Case-Control Studies

KW - Child

KW - Groin

KW - Humans

KW - Magnetic Resonance Imaging

KW - Male

KW - Physical Examination

KW - Pubic Symphysis

KW - Soccer

KW - Tomography, X-Ray Computed

U2 - 10.1136/bjsports-2014-094436

DO - 10.1136/bjsports-2014-094436

M3 - Journal article

C2 - 26031648

SN - 0306-3674

VL - 49

SP - 828

EP - 834

JO - British Journal of Sports Medicine

JF - British Journal of Sports Medicine

IS - 12

ER -