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Sportverletz Sportschaden 2018; 32(01): 27-34
DOI: 10.1055/s-0043-122763
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Was wissen wir über die Osteitis pubis bei Sporttreibenden?

What do we know about osteitis pubis in athletes?
Jens Kelm
  Orthopädie, Chirurgisch-Orthopädisches Zentrum
,
Oliver Ludwig
  Orthopädie, Chirurgisch-Orthopädisches Zentrum
,
Jan André
  Orthopädie, Chirurgisch-Orthopädisches Zentrum
,
Stefan Maas
  Orthopädie, Chirurgisch-Orthopädisches Zentrum
,
Sascha Hopp
  Orthopädie, Chirurgisch-Orthopädisches Zentrum
› Author Affiliations
Further Information

Publication History

Publication Date:
08 February 2018 (online)

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Zusammenfassung

Hintergrund Die Osteitis pubis ist eine häufige Ursache chronischer Leistenbeschwerden. Aufgrund hoher klinischer Unsicherheit sowie dem unterschiedlichen Verlauf der Erkrankung wird die Diagnose nicht selten erst spät gestellt. Das Krankheitsbild betrifft insbesondere Sportlerinnen und Sportler, wobei auch Patienten aus den Bereichen Orthopädie, Traumatologie, Neurologie, Urologie, Gynäkologie sowie der Rheumatologie betroffen sein können. Therapeutisch kommen sowohl konservative als auch operative Verfahren zum Einsatz.

Material und Methoden Systematische Literaturrecherche, deskriptive Darstellung der Studienlage und Interpretation der Ergebnisse im Sinne der evidenzbasierten Medizin.

Ergebnisse Das wissenschaftliche Niveau der Studien über die Osteitis pubis ist, wie die Anzahl der in Studien inkludierten Sporttreibenden, insgesamt niedrig. Aufgrund der Heterogenität der Publikationen ist ihr statistischer Vergleich methodisch schwierig. Klinisch führendes Symptom der Osteitis pubis ist die schmerzhafte Symphysis pubica, wobei ein klassisches pathognomonisches Zeichen fehlt. Die Diagnose basiert nach Ausschluss zahlreicher Differentialdiagnosen (z. B. „Sportlerleiste“, FA-Impingement, Adduktorenläsion) auf der Zusammenschau von Anamnese, klinischer Untersuchung sowie bildgebender Verfahren. Die Osteitis pubis ist eine durch Sportkarenz oftmals selbstlimitierende Erkrankung, die initial konservativ behandelt wird. Bei frustranem Verlauf sind operative Verfahren, in Abhängigkeit der Begleitpathologien, in Betracht zu ziehen.

Schlussfolgerung Es existieren bis dato keine Leitlinien hinsichtlich Diagnostik und Therapie der Osteitis pubis, allerdings ein Konsens darüber, dass der operativen Behandlung eine konservative vorangehen muss. Das Evidenzniveau der Studien ist niedrig. Eine metaanalytische Auswertung ist mit den derzeitig vorhandenen Publikationen nicht möglich. Die Anzahl der untersuchten Sporttreibenden ist in Relation zu den sozioökonomischen Folgen der Erkrankung, insbesondere im Profisport, niedrig.

Abstract

Background Osteitis pubis is a common cause of chronic groin pain. Due to high clinical uncertainty and varying etiopathology, the diagnosis is often delayed. Especially athletes suffer from this disease, but patients with orthopaedic, traumatological, neurological, urological, gynaecological, and rheumatic complaints can also be affected. Osteitis pubis can be treated by conservative as well as surgical techniques.

Material and Methods Systematic literature research, descriptive presentation of the studies, and interpretation of evidence-based medicine results.

Results The scientific level of studies about osteitis pubis and the number of athletes included are low overall. A statistical comparison is methodically difficult due to the heterogeneity of publications. The leading clinical symptom of osteitis pubis is an aching symphysis pubica. Unfortunately, there are no characteristic clinical pathognomonic signs. The medical diagnosis is based on an exclusion of various differential diagnoses (e. g. sports hernia, femoroacetabular impingement, adductor lesion) and a comparison of medical history, clinical examination, and imaging methods. After a period of rest, osteitis pubis is quite often a self-limiting disease and will initially be treated conservatively. If this fails, surgical intervention has to be considered depending on concurrent pathologies.

Conclusion Specific guidelines for the diagnosis and treatment of osteitis pubis do not exist as yet. But there is consensus that a surgical intervention should only be performed if conservative treatment fails. The level of evidence for the studies is low. A meta-analytical evaluation based on the existing publications is not possible as yet. The number of recorded athletes in relation to the socio-economic consequences of the disease, especially in professional sport, is low.

Schlüsselwörter

Osteitis pubis - systematische Literaturrecherche - Evidenzniveau - klinische Symptomatik - Diagnostik - Therapie

Key words

Osteitis pubis - systematic literature research - evidence-based level; clinical - symptoms - diagnostics - treatment
 

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