Original Research Magnetic Resonance Findings of Osteitis Pubis Burak Kunduracioglu MD, 1 Cengiz Yilmaz, MD, 2 * Mehmet Yorubulut, MD, 3 and Savas Kudas, MD 1 Purpose: To determine the correlation of MR findings with clinical features of osteitis pubis and to look for associating injuries complicating chronic cases. Materials and Methods: Pelvic MR images of the 22 elite athletes with groin pain were taken. Correlation analysis between the MR findings and clinical properties was carried out. Results: Six of the MR findings had strong correlation with duration of symptoms. Subchondral bone marrow edema, fluid in symphysis pubis joint, and periarticular edema had significant correlation with acuity of the case. On the con- trary, subchondral sclerosis, subchondral resorption and bony margin irregularities, and osteophytes correlated with the chronicity of the case. Associated tendon injuries cor- related with the duration of symptoms; i.e., all tendon in- juries were in chronic cases. Conclusion: Subchondral bone marrow edema, fluid in symphysis pubis joint, and periarticular edema are the most reliable MRI findings of osteitis pubis that has a his- tory of less than six months. Subchondral sclerosis, sub- chondral resorption and bony margin irregularities, and osteophytes (or pubic beaking) are the most reliable MRI findings of the chronic disease that has been present for more than six months. Associated pathologies, especially adductor or other tendon injuries, underlie more than half of the chronic cases of osteitis pubis. Key Words: osteitis pubis; magnetic resonance imaging; diagnosis; tendonitis; groin pain J. Magn. Reson. Imaging 2007;25:535–539. © 2007 Wiley-Liss, Inc. OSTEITIS PUBIS, also known as pubalgia or athletic pubalgia, is one of the most chronic and debilitating syndromes affecting athletes (1). It is described as the pubic bone stress injury occurring usually as a result of chronic overload or impaction trauma (2,3). Jumping, twisting, or turning motions during sprinting, cutting, and kicking activities have been implicated in the pathogenesis of osteitis pubis (1). These activities are most prevalent in sports like soccer. Patients usually refer with groin pain. But the differential diagnosis of the groin pain might be complicated by many disorders like tendon injuries, avulsion fractures, stress frac- tures, and sports hernia. Conventional radiographs may offer some findings but these are commonly iden- tified in the absence of symptoms (2). MRI is capable of both diagnosing the disorder and aiding in differential diagnosis. MR findings have been reported for diagnosis of osteitis pubis, but it has been suggested that these findings appear before the onset of symptoms (4). Some findings, such as pubic beaking or symphyseal disk extrusion may exist in lack of symptoms (4,5). We planned a study to determine MR findings that corre- lated with the clinical properties such as duration of symptoms, severity of the disease, and length of sports life. We also wanted to see if associating injuries com- plicated osteitis pubis in chronic cases. MATERIALS AND METHODS Institutional ethical committee permission was ob- tained for conduction of the study. Informed consent was received from the patients and the rights of the patients were protected. Elite athletes who had been referred to the sports medicine clinic with groin pain were assessed. Those who had been symptomatic for more than six weeks and who received a possible diagnosis of osteitis pubis were included in the study. Of the 22 male patients who were included in the study, 18 played soccer for a living. Three patients played soccer at least three times a week and one patient was a professional handball player. The time that the patients have been dealing with sports varied between six years to 20 years (mean 13 years). The age of the patients ranged between 17 and 43 years with an average of 28 years. Patients complained of groin pain for an average duration of 11 months (range 1.5 months to 72 months). A total of 16 patients com- plained of unilateral adductor region pain and the re- maining six had bilateral complaints. Pain was exacer- bated during kicking. Six patients’ pain radiated to the lower abdominal region. On physical examination the symphysis pubis was tender in all. Tenderness at the adductor muscle origins was detected in six patients. 1 Department of Sports Medicine, Ankara University Medical School, Ankara, Turkey. 2 Department of Orthopedics and Traumatology, Mersin University Medical School, Mersin, Turkey. 3 Integra MR, Ankara, Turkey. *Address reprint requests to: C.Y., Mersin Univ. Tip Fak. Hastanesi, Ortopedi ve Tavmatoloji AD, Zeytinlibahce mah, Mersin, 33079, Tur- key. E-mail: cyilmaz@doctor.com Received March 16, 2006; Accepted September 19, 2006. DOI 10.1002/jmri.20818 Published online in Wiley InterScience (www.interscience.wiley.com). JOURNAL OF MAGNETIC RESONANCE IMAGING 25:535–539 (2007) © 2007 Wiley-Liss, Inc. 535