Clinical results of surgical treatment for athletic pubalgia
Authors: Pedrinelli Andre , Fernandes João Vitor de Castro , Filho Carlos Guilherme Dorileo Leite , de Almeida Adriano Marques , Fernandes Tiago Lazzaretti , Hernandez Arnaldo José 
Published: October 2022

Abstract
Athletic pubalgia, first described in 1916 and first related to sport in a publication in 1932, is a condition characterized by pain in the inguinal region that causes a large number of absences from competitive physical activity, being very common in soccer. There is a wide variety of lesions that can affect the pubic symphysis region, which is composed of different musculoskeletal structures. The taxonomies described also vary and constitute additional diagnostic difficulties. This injury occurs by repetitive overload and not counterbalanced by the abdominal muscles, hip flexors and adductors in susceptible athletes. Pubis's injury may be related to the adductor or iliopsoas musculature, disorders in the inguinal canal, pubic symphysis, hip joint, or be due to other causes, such as occult hernias. Pubic symphysis injuries in athletes can affect not only the athlete's career, but also have a major financial impact on both the athlete and his team. Due to the low specificity of the symptoms in an anatomical region with multiple diagnostic possibilities, it is difficult to confirm the diagnosis and, consequently, the most appropriate therapy in disorders of the pubic symphysis. The main objective was to evaluate the outcomes of the surgical treatment of pubalgia with the technique used by the Sports Medicine Group (GME) of the Institute of Orthopedics and Traumatology of Hospital das Clínicas - Universidade de São Paulo. The secondary objective is to characterize and standardize the diagnostic and therapeutic methods used in the management of this complex musculoskeletal dysfunction. The present study is a consecutive historical cohort analysis of the medical records of the cases examined and operated on from 01/01/2002 to 12/31/2016 by the same surgeon. A total of 45 medical records were evaluated. All athletes are male, 75.6% professional soccer athletes, with a mean age of 23.9 years (SD5.86), 80.5% without associated trauma, 58.5% with progressive pain. The time to return to competitive sport was 94 days (median), with 93.3% of good results. The start of symptoms, attacker position and age included in the model were overall significant in predicting discharge period. But only the attacker 's position had a statistically significant value. The outcome of the procedure occurred in 94 days (median) in professional athletes, showing a positive relationship with the playing position (attackers), with 93.7% of good results, proving to be a good option for the treatment of this disease. Background: This text represents our institution's experience concerning the athletic pubalgia treatment. As we are a FIFA Medical Center of Excellence we are entitled to study and understand football lesions. Purpose: Athletic pubalgia is characterized by pain in the inguinal region. Taxonomies vary and account for difficulties in diagnosis. The injury may be related to the adductor musculature, inguinal canal disorders, pubic symphysis, hip joint or occult hernias. As symptoms lack specificity, it is difficult to confirm diagnosis and the appropriate treatment. To assess the outcome of surgical treatment of myotendinous athletic pubalgia. Methods: This study is a consecutive cohort analysis of 45 patients operated between 11 2002 and 2016. Results: All athletes were male, 75.6% professional soccer players, their mean age was 23.9 (SD 5.86), 80.5% had no trauma and 58.5% progressive pain. Return time to sport was 94 days. Conclusion: The procedure outcome showed 93.7% of good results, proving to be a good treatment option.