Prevalence of Pubic-Related Radiographic Findings in Symptomatic and Asymptomatic High-Impact Athletes: Bridging Imaging and Clinical Relevance

Purpose or Learning Objective: To determine the prevalence and severity of radiographic findings of the pubic symphysis in sub-elite football players (soccer or Australian football) with and without hip/groin pain and to compare radiographic findings separately in male and female football players.

Methods or Background: We included 184 symptomatic (> 6 months hip/groin pain; age: 26 years; 21% women) and 55 asymptomatic (no pain; age: 26 years; 26% women) football players from the Femoroacetabular Impingement and Hip Osteoarthritis Cohort study. Supine anteroposterior pelvic radiographs were obtained and radiographic findings of the pubic symphysis (bone lucency [erosions and cysts], bony proliferation, sclerosis, and fragmentation) were quantified by the Aspetar scoring protocol. A musculoskeletal radiologist and a sports medicine physician independently evaluated all radiographs. Interobserver variability was calculated using prevalence-adjusted bias-adjusted kappa. Associations between the independent variables of interest (hip/groin pain and sex) and radiographic findings were assessed separately using chi-square tests. Differences in the severity of radiographic findings were evaluated with negative binomial regression models.

Results or Findings: Interobserver reliability was fair to almost perfect (prevalence-adjusted bias-adjusted kappa: 0.37–0.93). The prevalence of cysts (17% versus 5%; P = 0.029) was higher in symptomatic compared with asymptomatic football players. Proliferation, erosions, sclerosis, and fragmentation prevalence did not differ between symptomatic and asymptomatic football players. The severity of radiographic findings did not differ between asymptomatic and symptomatic football players (incidence rate ratio [IRR] 1.11; 95% confidence interval [CI] 0.90–1.36; P = 0.334). The prevalence of erosions (28% versus 10%; P = 0.009) and sclerosis (69% versus 44%; P = 0.001) was higher in male relative to female football players. Bony proliferation was more common in female (54% versus 31%; P = 0.003) than male football players. Cyst and fragmentation prevalence did not differ between male and female football players. Radiographic severity was greater in male relative to female football players (IRR 1.43; 95% CI 1.10–1.86; P = 0.009).

Conclusion: The prevalence and severity of radiographic findings of the pubic symphysis were mostly similar in football players with and without hip/groin pain. Sex-based differences were identified, with male football players having a higher prevalence of erosions and sclerosis, whereas bony proliferation is more common in females. More severe radiographic pubic symphysis findings were evident in male football players compared with females.

Publication History

Article published online:
02 June 2025