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Pubic apophysitis: a previously undescribed clinical entity of groin pain in athletes
  1. Matthieu Sailly1,
  2. Rod Whiteley2,3,
  3. John W Read4,
  4. Bruno Giuffre3,5,
  5. Amanda Johnson2,6,
  6. Per Hölmich7,8,9
  1. 1Centre Medical Synergie, Lausanne, Switzerland
  2. 2Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  3. 3University of Sydney, Sydney, New South Wales, Australia
  4. 4Castlereagh Imaging, St Leonards, Australia
  5. 5Radiology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
  6. 6University of Manchester, Manchester, UK
  7. 7Aspetar Sports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  8. 8Arthroscopic Center Amager, Sports Orthopedic Research Center, Copenhagen, Denmark
  9. 9Copenhagen University Hospital, Amager-Hvidovre, Denmark
  1. Correspondence to Dr Matthieu Sailly, Centre Medical Synergie, Rue du Grand Pré 2b, Lausanne CH-1007, Switzerland; matthieusailly{at}yahoo.fr

Abstract

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.

  • Adolescent
  • Tendon
  • Growth
  • Pelvic
  • Soccer

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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