Summary

Athletic pubalgia occurs by repetitive overload in susceptible athletes. Due to the low specificity of the symptoms, it is difficult to confirm the diagnosis and appropriate therapy in this disorder. The main objective was to evaluate the outcomes of the surgical treatment and standardize the diagnostic and therapeutic methods used in the management of this complex musculoskeletal dysfunction.

Abstract

Athletic pubalgia, described for the first time in 1916 and associated for the first time to sport in publication in 1932, is an affection characterized by pain in the inguinal region that causes a great number of leave of absence of competitive physical activity being very frequent in soccer. There is a great variety of lesions that occur in the pubic symphysis, which is composed of different musculoskeletal structures. Described taxonomies also vary and are additional difficulties to diagnosis. This lesion occurs because of repetitive and not counterbalanced abdominal muscles overload, mainly from hip flexors and adductors in susceptible athletes. Pubis’ injury may be related to adductors and iliopsoas musculature, inguinal channel or pubic symphysis or hip joint disorders, or be due to other causes, like hidden hernias. Pubic symphysis injuries in athletes may affect not only the athlete's career, but also have a major financial impact for both the athlete and its team. Due to low specificity of symptoms in an anatomic region with multiple diagnostic possibilities, it becomes difficult to confirm diagnosis and consequent adequate therapy in pubic symphysis disorders. Primary objective was to evaluate outcomes of surgical treatment of pubalgia with the technique used by a recognized Sports Medicine Group at a Brazilian University in a large city. The secondary aim is to characterize and build standard diagnostic and therapeutic methods in the management of this complex osteomuscular dysfunction. The present study, a consecutive cohort historic analysis of cases assessed and operated on by the same surgeon from 01/01/2002 to 12/31/2016. A total of 45 patient files were evaluated. Clinical assessment, imaging and muscle force protocols are described. Forty-five patient files were evaluated: all athletes were male, 75,6% were professional soccer players, with mean age of 23,9 years (SD 5,86), 80,5% with no associated trauma, 58,5% of progressive pain. The time to return to competitive sport was 97 days (median) with mean 93,3% of good results. The start of symptoms, attacker position and age included in the model were overall significant in predicting discharge period. But only the attacker 's position had a statistically significant value. The outcome of the procedure was in 94 days (median) in professional athletes, showing positive correlation with player’s position (attackers), with 93,7% of good results, becoming a good option for this injury’s treatment.