Pubic-Related Radiographic Findings in Male Football Players With Long-Standing Groin Pain, and Asymptomatic Controls - Are They Clinically Relevant?

The Aspetar pubic symphysis radiographic scoring protocol is reliable in male football players, but its clinical significance is unclear. We investigated the prevalence of pubic-related radiographic findings and their association with groin pain and disability in male football players and asymptomatic controls. We included 39 symptomatic male football players with long-standing groin pain, 18 asymptomatic male football players, and 20 asymptomatic male non-football athletes. Standing anteroposterior pelvic radiographs were analyzed by two radiologists for pubic-related bone lucency, proliferation, sclerosis, fragmentation, and joint space width (JSW, millimeters). Findings were combined into a Pubic Symphysis Radiographic Severity Score (PSRS Score, 0-8). Groin pain and disability were measured using the Five-Second Squeeze Test (5SST, 0-10) and the Hip and Groin Outcome Score (HAGOS, 100-0). For symptomatic football players, asymptomatic football players, and asymptomatic non-football athletes, the pubic-related radiographic findings prevalence's were, respectively: bone lucency: 87%, 83%, and 40%; proliferation: 67%, 61%, and 25%; sclerosis: 64%, 50%, and 15%; and fragmentations: 15%, 6%, and 0%, while the mean JSW was 3 mm in all three groups. There were no differences between symptomatic and asymptomatic football players in any findings (p ≥ 0.39). Bone lucency, proliferation, and sclerosis were more frequent in football players than non-football athletes (p < 0.002). PSRS Score showed poor correlation with 5SST and HAGOS. In conclusion, pubic-related radiographic findings are not associated with groin pain or disability. Pubic-related radiographic findings are more common in male football players than male non-football athletes.