Objectives: We examined the most current evidence for treatment options in athletes with osteitis pubis and osteomyelitis pubis, attempting to determine which options provide optimal pain relief with rapid return to sport and prevention of symptom reoccurrence.
Methods: Three databases-MEDLINE, Cochrane Database of Systematic Reviews and CINAHL were searched using the OVID interface for all years between 1985 and May 2008. References were analyzed from included studies and additional relevant articles were obtained for inclusion. Inclusion criteria included: 1) humans only, (2) subjects had no apparent risk factors for development of osteitis pubis or osteomyelitis of the pubic symphysis other than athletic involvement, (3) both physical exam findings and diagnostic imaging were used to confirm either diagnosis, and (4) a definitive treatment strategy was identifiable for management of osteitis pubis or osteomyelitis of the pubic symphysis. In total, 25 articles were included in the review.
Results: There were no randomized controlled trials (RCTs) identified with our search strategy.
195 athletes were diagnosed with osteitis pubis (186 males, 9 females) and treated with either conservative measures/physical therapy, local injection with corticosteroids and/or local anesthetic, dextrose prolotherapy, surgery or antibiotic therapy. Six case reports/series described conservative treatment measures (physical therapy, rest, NSAIDs). Four case series explored the use of corticosteroid injections in treatment. One case series described the use of dextrose prolotherapy as a treatment modality. Six case series described various surgical techniques (pubic symphysis curettage, polypropylene mesh placement, and pubic bone stabilization) in treatment. Ten case reports/series (10 subjects) outlined antibiotic treatment of osteomyelitis of the pubic symphysis.
Conclusions: The current medical literature shows only level 4 evidence for the treatment of osteitis pubis in twenty-four case reports/series in athletes. Without any direct comparison of treatment modalities it is difficult to determine which individual treatment option is the most efficacious. Further study comparing the different treatment options is necessary to determine which modality provides the fastest return to sport.