Francesco Gaudino1, Daniel Spira2, Yannic Bangert3, Henning Ott4, Bruno Beomonte Zobel5, Hans-Ulrich Kauczor2, Marc-André Weber6. 1. Department of Diagnostic and Interventional Radiology, University Hospital Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, 00128 Rome, Italy; Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld, 110, 69120 Heidelberg, Germany. Electronic address: franz.gaudino@gmail.com. 2. Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld, 110, 69120 Heidelberg, Germany. 3. Department of Orthopedic and Trauma Surgery, University Hospital of Heidelberg, Schlierbacher Landstraße, 200a, 69118 Heidelberg, Germany. 4. Altius Swiss Sportmed Center Rheinfelden, Habich-Dietschy-Strasse, 5, 4310 Rheinfelden, Switzerland. 5. Department of Diagnostic and Interventional Radiology, University Hospital Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, 00128 Rome, Italy. 6. Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld, 110, 69120 Heidelberg, Germany; Institute of Diagnostic and Interventional Radiology, Rostock University Medical Center, Schillingallee, 35, 18057 Rostock, Germany.
Abstract
BACKGROUND AND PURPOSE: Osteitis pubis (OP), a common pathology in elite athletes, is an aseptic inflammatory process of the pubic symphysis bone, and may involve surrounding soft tissues, tendons and muscles. OP is typically characterized by (often recurring) groin pain and is an important cause of time-off from sports activity in athletes. Aim of this retrospective study was to analyze magnetic resonance imaging (MRI) findings in professional football players with clinical diagnosis of OP and to correlate MRI findings with clinical outcome. MATERIAL AND METHODS: All professional football players (23 males, 1 female; mean age: 21±3.7years; range: 16-30 years) with groin pain and clinical diagnosis of OP, who underwent pelvic MRI in our institution were retrospectively analyzed. The MR images were analyzed regarding the presence of bone marrow edema and its extension, whether fluid in the symphysis pubis or periarticular soft tissue edema with a rim-like periosteal distribution or edema in the muscles located around the symphyseal joint were present, whether degenerative changes of the symphysis pubis and of signs of symphyseal instability were encountered. A quantitative measurement of the signal intensity in bone marrow edema on 3T STIR sequences was performed, normalizing these values to the mean signal intensity values in the ipsilateral iliopsoas muscle. All patients were classified according to a 3-point grading scale. For each patient, both the symptoms 18 months after the initial MRI examination, the duration of time off from playing football and the kind of treatment applied were evaluated. RESULTS: Among all professional athletes, in 20/24 (83.3%) MRI showed signs of OP with bone marrow edema at the pubic bone. 12 of these patients showed complete clinical recovery without any symptoms after 18 months, while in 8 patients partial recovery with persistence of groin pain during higher sports activity was observed. Patients with edema in periarticular soft tissues or in the muscles around the symphyseal joint on MRI at the beginning of symptoms presented significantly more often with a partial recovery after returning to high sports activity (p=0.042 and p=0.036, respectively). A partial recovery was also significantly associated with higher normalized mean signal intensity values in bone marrow edema on STIR sequences at the beginning of symptoms (mean=4.77±1.63 in the group with partial recovery vs. mean=2.86±0.45 in the group with complete recovery; p=0.0019). No significant association was noticed between MRI findings and time of abstinence from high sports activity, as well as between the 3-point grading scale and the time off from high sport activity and recovery at 18 months. CONCLUSIONS: Edema in periarticular soft tissues, edema with extension to the muscles located around the symphyseal joint, as well as higher normalized signal intensity values in bone marrow edema on STIR sequences in the pubic bones at the beginning of groin pain are the most reliable MRI findings of a poor clinical long-term outcome of OP in professional football players and should be regarded as negative prognostic factors.
BACKGROUND AND PURPOSE:Osteitis pubis (OP), a common pathology in elite athletes, is an aseptic inflammatory process of the pubic symphysis bone, and may involve surrounding soft tissues, tendons and muscles. OP is typically characterized by (often recurring) groin pain and is an important cause of time-off from sports activity in athletes. Aim of this retrospective study was to analyze magnetic resonance imaging (MRI) findings in professional football players with clinical diagnosis of OP and to correlate MRI findings with clinical outcome. MATERIAL AND METHODS: All professional football players (23 males, 1 female; mean age: 21±3.7years; range: 16-30 years) with groin pain and clinical diagnosis of OP, who underwent pelvic MRI in our institution were retrospectively analyzed. The MR images were analyzed regarding the presence of bone marrow edema and its extension, whether fluid in the symphysis pubis or periarticular soft tissue edema with a rim-like periosteal distribution or edema in the muscles located around the symphyseal joint were present, whether degenerative changes of the symphysis pubis and of signs of symphyseal instability were encountered. A quantitative measurement of the signal intensity in bone marrow edema on 3T STIR sequences was performed, normalizing these values to the mean signal intensity values in the ipsilateral iliopsoas muscle. All patients were classified according to a 3-point grading scale. For each patient, both the symptoms 18 months after the initial MRI examination, the duration of time off from playing football and the kind of treatment applied were evaluated. RESULTS: Among all professional athletes, in 20/24 (83.3%) MRI showed signs of OP with bone marrow edema at the pubic bone. 12 of these patients showed complete clinical recovery without any symptoms after 18 months, while in 8 patients partial recovery with persistence of groin pain during higher sports activity was observed. Patients with edema in periarticular soft tissues or in the muscles around the symphyseal joint on MRI at the beginning of symptoms presented significantly more often with a partial recovery after returning to high sports activity (p=0.042 and p=0.036, respectively). A partial recovery was also significantly associated with higher normalized mean signal intensity values in bone marrow edema on STIR sequences at the beginning of symptoms (mean=4.77±1.63 in the group with partial recovery vs. mean=2.86±0.45 in the group with complete recovery; p=0.0019). No significant association was noticed between MRI findings and time of abstinence from high sports activity, as well as between the 3-point grading scale and the time off from high sport activity and recovery at 18 months. CONCLUSIONS:Edema in periarticular soft tissues, edema with extension to the muscles located around the symphyseal joint, as well as higher normalized signal intensity values in bone marrow edema on STIR sequences in the pubic bones at the beginning of groin pain are the most reliable MRI findings of a poor clinical long-term outcome of OP in professional football players and should be regarded as negative prognostic factors.
Authors: Kai-Jonathan Maas; Maxim Avanesov; Azien Laqmani; Julius Weinrich; Markus Sauer; Michael G Kaul; Gerhard Adam; Marc Regier; Cyrus Behzadi Journal: PLoS One Date: 2018-08-22 Impact factor: 3.240
Authors: Luis Ceballos-Laita; Ignacio Hernando-Garijo; Ricardo Medrano-de-la-Fuente; María Teresa Mingo-Gómez; Andoni Carrasco-Uribarren; Sandra Jiménez-Del-Barrio Journal: Int J Environ Res Public Health Date: 2022-10-06 Impact factor: 4.614