title: Pubic apophysitis: a previously undescribed clinical entity of groin pain in athletes.
abstract: BACKGROUND
  Sport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on adolescents. Cadaveric and imaging studies identify a secondary ossification centre located along the anteromedial corner of pubis beneath the insertions of symphysial joint capsule and adductor longus tendon. Little is known about this apophysis and its response to chronic stress.
  
  
  OBJECTIVE
  We report pubic apophysitis as a clinically relevant entity in adolescent athletes.
  
  
  METHODS
  The clinical and imaging findings in 26 highly trained adolescent football players (15.6 years ± 1.3) who complained of adductor-related groin pain were reviewed. The imaging features (X-ray 26/26, US 9/26, MRI 11/26, CT 7/26) of the pubic apophyses in this symptomatic group were compared against those of a comparison group of 31 male patients (age range 9-30 years) with no known history of groin pain or pelvic trauma, who underwent pelvic CT scans for unrelated medical reasons.
  
  
  RESULTS
  All symptomatic subjects presented with similar history and physical findings. The CT scans of these patients demonstrated open pubic apophyses with stress-related physeal changes (widening, asymmetry and small rounded cyst-like expansions) that were not observed in the comparison group. No comparison subject demonstrated apophyseal maturity before 21 years of age, and immaturity was seen up to the age of 26 years.
  
  
  CONCLUSIONS
  This retrospective case series identifies pubic apophyseal stress (or 'apophysitis') as an important differential consideration in the adolescent athlete who presents with groin pain.
authors.affiliation: Centre Medical Synergie, Lausanne, Switzerland.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Sailly
authors.affiliation: Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Rod
authors.initials: R
authors.lastname: Whiteley
authors.affiliation: Castlereagh Imaging, St Leonards, Australia.
authors.forename: John W
authors.initials: JW
authors.lastname: Read
authors.affiliation: University of Sydney, Sydney, New South Wales, Australia Radiology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Bruno
authors.initials: B
authors.lastname: Giuffre
authors.affiliation: Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar University of Manchester, Manchester, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Johnson
authors.affiliation: Aspetar Sports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Arthroscopic Center Amager, Sports Orthopedic Research Center, Copenhagen, Denmark Copenhagen University Hospital, Amager-Hvidovre, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Hölmich
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000473:pathology* / Q000534:rehabilitation; D000293:Adolescent; D001168:Arthritis / Q000150:complications / Q000473:pathology* / Q000534:rehabilitation; D016022:Case-Control Studies; D002648:Child; D006119:Groin / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010808:Physical Examination; D011631:Pubic Symphysis / Q000473:pathology*; D012916:Soccer / Q000502:physiology*; D014057:Tomography, X-Ray Computed
keywords: Adolescent; Growth; Pelvic; Soccer; Tendon