Use of Pubic Symphysis Curettage for Treatment-Resistant Osteitis Pubis in Athletes

Abstract

Background In athletes, osteitis pubis is regarded as a problem of overuse, with instability and movement of the anterior pelvis. There is no evidence to conclusively support any treatment modality. Recovery with nonoperative management can take an extended period of time, often unsatisfactory for professional athletes. Hypothesis Curettage of the pubic symphysis is a viable option for nonoperative treatment of resistant osteitis pubis in athletes. Study Design Case series; Level of evidence, 4. Methods This retrospective study presents the results of curettage of the pubic symphysis in 23 athletes with osteitis pubis that was refractory to initial nonoperative therapies. Patients met the criteria for the study if they had symptoms suggestive of osteitis pubis and underwent isolated pubic symphysis curettage. The discomfort had been present for a mean of 13.22 months before presentation. Patients were reviewed at 24.31 months (range, 12.5–59.6 months) postoperatively. Twelve of the patients also underwent a postoperative magnetic resonance imaging scan at 19.10 months; any findings of residual osteitis pubis were noted. Results Mean visual analog scale for pain improved from 6.9 preoperatively to 2.8 postoperatively (P = .36). Twenty-one patients returned to pain-free running by 3.14 months (range, 1.5–6 months), 17 to training by 4.44 months (range, 2.5–7 months), and 16 to full activity by 5.63 months (range, 2.5–12 months). Overall, 61% of patients reported an activity grade of 4 at postoperative review, defined as no pain with full activity. There were no significant postoperative complications in the study group. Marrow edema improved in most cases for which magnetic resonance imaging was available preoperatively and postoperatively. Patient satisfaction with the procedure was high, with 78% of participants feeling their symptoms were better or much better than preoperatively. Conclusion The authors suggest that this relatively simple procedure can be of significant benefit to those athletes wishing to return to their previous levels of physical activity when more nonoperative measures have proven unsuccessful.