Abstract
Osteitis pubis (OP) is a self-limiting, noninfectious inflammatory disease of the pubic symphysis and the surrounding soft tissues that usually improves with activity modification and targeted conservative treatment. Surgical treatment is required for a limited number of patients. This study aims to investigate the current literature on the surgical treatment of OP in athletes.A systematic review was conducted on two databases (MEDLINE/PubMed and Google Scholar) from 2000 to 2021. The inclusion criteria were adult patients with athletic OP who underwent surgical treatment and studies published in English. The exclusion criteria included pregnancy, infection OP, or postoperative complications related to other surgical interventions, such as urological or gynecological complications.Fifty-one surgically treated cases have been reported in eight studies, which included short-term, mid-term, and long-term studies ranging from one patient to 23 patients. The surgical treatment methods were as follows: (a) pubic symphysis arthrodesis, (b) open or endoscopic pubic symphysectomy, (c) wedge resection of the pubic symphysis, and (d) polypropylene mesh placed into the preperitoneal retropubic space endoscopically.The main indication for surgical intervention was failure of conservative measures and long-lasting pain, disability, and inability to participate in athletic activities. Wedge resection of the pubic symphysis has been the less preferred surgical treatment in the recently published literature. The most common surgical method of treatment of OP in athletes, which entailed the existence of posterior stability of the sacroiliac joint, in the current literature is open pubic symphysis curettage. Recently, there has been a tendency for pubic symphysis curettage to be performed endoscopically.
Highlights
BackgroundOsteitis pubis (OP) in athletes is an idiopathic inflammatory condition that affects the pubic symphysis and the surrounding soft tissues and is caused by overuse or trauma [1-7]
OP is a self-limiting disease that improves with activity modification and individualized conservative treatment, while surgical treatment is required for about 5% to 10% of patients
This study aims to investigate the current literature on the surgical treatment of OP in athletes
Summary
Osteitis pubis (OP) in athletes is an idiopathic inflammatory condition that affects the pubic symphysis and the surrounding soft tissues and is caused by overuse or trauma [1-7]. It was first documented as a complication after suprapubic surgery by Beer in 1924, but it was later renamed athletic OP by Spinelly in 1932 [5]. OP is more common in high-level athletes, who train intensively, such as soccer, rugby, Australian Rules football, distance running, and ice hockey players [6,7]. It is characterized by pain in the pubic symphysis that worsens with physical activity. This review aims to answer the following questions: (a) which is the most preferred surgical technique in the last two decades, (b) what are the perioperative complications, and (c) what is the time span required to return to full activity and what the percentage of athletes who returned to full activity after the surgical treatment?
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