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Osteitis Pubis and Assessment of Bone Marrow Edema at the Pubic Symphysis With MRI in an Elite Junior Male Soccer Squad

Lovell, Greg MBBS, FACSP*; Galloway, Howard BMBS, FRANZCR; Hopkins, Will PhD, FACSM; Harvey, Ann MB ChB, FFRad(D)§

Clinical Journal of Sport Medicine: March 2006 - Volume 16 - Issue 2 - p 117-122
Original Research
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Objectives To assess bone marrow edema at the pubic symphysis with magnetic resonance imaging (MRI), and its relation to training and osteitis pubis in an elite group of junior soccer players.

Setting Soccer players on scholarship at the Australian Institute of Sport (AIS).

Patients Nineteen players from an elite junior men's soccer squad.

Intervention/Assessment Serial MRI examinations of the pubic symphysis over a 4-month training and playing period, training session questionnaire, and review of clinical diagnosis, investigations, and records on presentation of athletes with groin pain at the Department of Sports Medicine.

Main Outcome Measures Assessment of bone marrow edema (4-point scale) on MRI scans, review of athlete questionnaires, and review of clinical records.

Results Initial MRI scans showed moderate to severe bone marrow edema at the pubic symphysis in 11 of the 18 asymptomatic players. There was a greatly decreased risk of developing groin pain (osteitis pubis) with more training prior to entry of the AIS soccer program (odds ratio per 4 sessions of training, 0.003). The correlation between initial bone marrow edema grading and pre-AIS training was small. The increase in bone marrow edema grading from baseline over the scans was 0.5 (90% CL, 0.4).

Conclusions Substantial amounts of bone marrow edema at the pubic symphysis can occur in asymptomatic elite junior soccer players, but it is only weakly related to the development of osteitis pubis. Progressing training loads more slowly in athletes presenting with low current training loads may be a useful strategy for the prevention of osteitis pubis in junior soccer players.

*Department of Sports Medicine, Australian Institute of Sport, Bruce, ACT, Australia

Department of Radiology, Canberra Hospital, Woden, ACT, Australia

NZ Institute for Sport and Recreation Research, Auckland University of Technology, Auckland, New Zealand

§Fremantle Hospital, WA, Australia

Reprints: Dr Greg Lovell, Department of Sports Medicine, Australian Institute of Sport, Leverrier Cres, Bruce, ACT, AUSTRALIA 2617 (e-mail: greg.lovell@ausport.gov.au)

Received for publication April 13, 2005 accepted October 12, 2005

© 2006 Lippincott Williams & Wilkins, Inc.