Download PDF
Int J Sports Med 2005; 26(4): 303-306
DOI: 10.1055/s-2004-820975
Clinical Sciences

© Georg Thieme Verlag KG Stuttgart · New York

Successful Treatment of Osteitis Pubis by Using Totally Extraperitoneal Endoscopic Technique

H. Paajanen1 , J. Heikkinen2 , H. Hermunen3 , I. Airo4
  • 1Department of Surgery, Central Hospital of Mikkeli, Mikkeli, Finland
  • 2Department of Nuclear Medicine, Central Hospital of Mikkeli, Mikkeli, Finland
  • 3Department of Radiology, Central Hospital of Mikkeli, Mikkeli, Finland
  • 4Diaconess Hospital of Helsinki, Helsinki, Finland
Further Information

Publication History

Accepted after revision: February 5, 2004

Publication Date:
10 September 2004 (online)

Also available at
    Permissions and Reprints

Abstract

Osteitis pubis is characterized by pain, inflammation, and sclerosis in the pubic symphysis. It is often a self-limiting disease in athletes, but persistent pain may occasionally need surgery. Video-assisted placement of extraperitoneal retropubic synthetic mesh to support the damaged area may hasten the healing of this injury. During 1997 - 2002 five elite level male athletes with chronic groin pain associated with osteitis pubis were operated. The diagnosis was based on clinical findings, x-ray, magnetic resonance imaging (MRI), and isotope bone scanning. A 10 × 15 cm polypropylene mesh was placed into preperitoneal retropubic space using video-assisted technique. The pain and return to sport were asked at 1, 6, and 12 months after surgery. Preoperative technetium bone scan revealed an enhanced isotope uptake of pubic bone in each patient. T2-weighted MRI (n = 3) indicated bone marrow edema, which was decreased postoperatively on repeated MRI scans. Periosteal edema and irritation were also seen at operation. No complications were associated with the insertion of mesh. All 5 athletes returned to their sport activites between one to two months after surgery. After one year, no tenderness or pain was observed in the pubic bone. When conservative treatment fails, the placement of retropubic mesh is safe and a mini-invasive method to hasten the rehabilitation of osteitis pubis in selected cases. The postoperative recovery was uneventful, and the patients returned rapidly to their sporting activities.

Key words

Groin pain - osteitis pubis - pubicitis - symphysitis - laparoscopy - mesh

References

  • 1 Akermark C, Johansson C. Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes.  Am J Sport Med. 1992;  20 640-643
    PubMedGoogle Scholar
  • 2 Ashby E C. Chronic obscure groin pain is commonly caused by enthesopathy: “tennis elbow” of the groin.  Br J Surg. 1994;  81 1632-1634
    PubMedGoogle Scholar
  • 3 Barile A, Erriquez D, Cacchio A, De Paulis F, Di Cesare E, Masciocchi C. Groin pain in athletes: role of magnetic resonance.  Radiol Med. 2000;  100 216-222
    PubMedGoogle Scholar
  • 4 Burke G, Levine M, Sabio H. Tc-99 m bone scan in unilateral osteitis pubis.  Clin Nucl Med. 1994;  19 535
    PubMedGoogle Scholar
  • 5 Ekberg O, Persson N H, Abrahamsson P A, Westlin N E, Lilja B. Longstanding groin pain in athletes. A multidisciplinary approach.  Sports Med. 1988;  6 56-61
    CrossrefPubMedGoogle Scholar
  • 6 Felix E L, Michas C A, Gonzales Jr M H. Laparoscopic hernioplasty. TAPP vs. TEP.  Surg Endosc. 1995;  9 984-989
    PubMedGoogle Scholar
  • 7 Fon L J, Spence A J. Sportsman's hernia.  Br J Surg. 2000;  87 545-552
    CrossrefPubMedGoogle Scholar
  • 8 Fricker P A, Taunton J E, Ammann W. Osteitis pubis in atheletes. Infection, inflammation or injury?.  Sports Med. 1991;  12 266-279
    CrossrefPubMedGoogle Scholar
  • 9 Holt M A, Keene J S, Graf B K, Helwig D C. Treatment of osteitis pubis in athletes. Results of corticosteroid injections.  Am J Sports Med. 1995;  23 601-606
    PubMedGoogle Scholar
  • 10 Ingoldby C JH. Laparoscopic and conventional repair of groin pain disruption in sportmen.  Br J Surg. 1997;  84 213-215
    CrossrefPubMedGoogle Scholar
  • 11 Kälebo P, Karlsson J, Swärd L, Peterson L. Ultrasonography of chronic tendon injuries in the groin.  Am J Sport Med. 1992;  20 634-639
    PubMedGoogle Scholar
  • 12 Lentz S S. Osteitis pubis: a review.  Obstet Gynecol Surv. 1995;  50 310-315
    PubMedGoogle Scholar
  • 13 Lynch S A, Renstrom P A. Groin injuries in sport: treatment strategies.  Sports Med. 1999;  28 137-144
    CrossrefPubMedGoogle Scholar
  • 14 MacArthur D C, Grieve D C, Thompson A M, Greig J O, Nixon J J. Herniography for groin pain of uncertain origin.  Br J Surg. 1997;  84 684-685
    CrossrefPubMedGoogle Scholar
  • 15 MacLeod D AD, Gibbon W W. The sportsman's groin.  Br J Surg. 1999;  86 849-850
    CrossrefPubMedGoogle Scholar
  • 16 Major N M, Helms C A. Pelvic stress injuries: the relationship between osteitis pubis (symphysis pubis stress injury) and sacroiliac abnormalities in atheletes.  Skeletal Radiol. 1997;  26 711-717
    CrossrefPubMedGoogle Scholar
  • 17 McMaster J, Wilson J A, McKenzie K, MacLeod D A. Management of groin pain.  The Lancet. 1995;  346 510
    PubMedGoogle Scholar
  • 18 Simonet W T, Saylor 3rd H L. Abdominal wall muscle tears in hockey players.  Int J Sports Med. 1995;  16 126-128
    PubMedGoogle Scholar
  • 19 Taylor D C, Meyers W C, Moylan J A, Lohnes J, Bassett F H, Garrett Jr W E. Abdominal musculature abnormalities as a cause of groin pain in athletes. Inguinal hernias and pubalgia.  Am J Sport Med. 1991;  19 239-242
    PubMedGoogle Scholar
  • 20 Verrall G M, Slavotinek J P, Fon G T. Incidence of pubic marrow oedema in Australian rules football players: relation to groin pain.  Br J Sports Med. 2001;  35 28-33
    CrossrefPubMedGoogle Scholar
  • 21 Wiley J J. Traumatic osteitis pubis: the gracilis syndrome.  Am J Sports Med. 1983;  11 360-363
    CrossrefPubMedGoogle Scholar
  • 22 Williams P R, Thomas D P, Downes E M. Osteitis pubis and instability of the pubic symphysis. When nonoperative measures fail.  Am J Sports Med. 2000;  28 350-355
    PubMedGoogle Scholar

H. Paajanen

Department of Surgery · Central Hospital of Mikkeli

Porrassalmenkatu 35 - 37

50100 Mikkeli

Finland

Phone: + 358443512220

Fax: + 35 81 53 51 22 55

Email: hannu.paajanen@esshp.fi

      >