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

## TL;DR

This study found that radiographic signs of pubic issues in male football players are common but not linked to groin pain or disability.

## Contribution

The study clarifies the clinical relevance of pubic-related radiographic findings in male football players.

## Key findings

- Pubic-related radiographic findings are not associated with groin pain or disability in football players.
- Football players show higher prevalence of these findings compared to non-football athletes.
- The PSRS score poorly correlates with measures of pain and disability.

## Abstract

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.