Prevalence and severity of pubic symphysis radiographic findings in male and female sub-elite football players with and without hip and/or groin pain.
Hanff DF, Weir A, Agricola R, Mosler AB, Kemp JL, Scholes MJ et al. · Skeletal radiology · 2026
Objective: To determine the prevalence and severity of radiographic features of the pubic symphysis in sub-elite football players (soccer and Australian football) with and without hip and/or groin pain, and to compare these features between men and women.
Materials and methods: Two hundred and thirty-nine football players (184 symptomatic, 55 asymptomatic; 187 men, 52 women) were included. Participants underwent a supine anteroposterior pelvic radiograph. Five pubic symphysis radiographic features were assessed using the Aspetar scoring protocol. Radiographic severity score was defined as the total number of radiographic features present (range 0-5). Two readers independently evaluated all radiographs. Regression analyses adjusted for age, sex (where applicable), body mass index, sport type, and training load compared radiographic feature prevalence and severity between groups.
Results: Radiographic feature prevalence and severity did not differ between symptomatic and asymptomatic participants. Men more frequently demonstrated erosion-like configuration (28% vs 10%; adjusted odds ratio (aOR) 3.58, 95% CI 1.32-9.71; p = 0.012) and sclerosis (70% vs 44%; aOR 2.46, 95% CI 1.25-4.84; p = 0.009), whereas bony proliferation and fragmentation were more common in women (54% vs 30%; aOR 0.34, 95% CI 0.18-0.66; p = 0.002 and aOR 0.25, 95% CI 0.08-0.78, p = 0.017, respectively). Radiographic severity score did not differ between men and women (adjusted incidence rate ratio (aIRR) 1.21, 95% CI 0.89-1.66; p = 0.227).
Conclusion: The prevalence and severity of radiographic features at the pubic symphysis did not differ between symptomatic and asymptomatic football players. However, sex-related differences in radiographic
Findings: were evident.