Prevalence of Symphyseal Radiographic Findings and Skeletal Maturity and Their Relationship With Groin Symptoms in...

OBJECTIVES: The primary aim was to assess the radiographic features of the pubic symphysis in elite female football players. The secondary aim was to explore associations between radiographic findings and groin complaints. DESIGN: Cross-sectional study. METHODS: This was a multicenter study of 100 elite female football players from three Dutch professional clubs. Players completed questionnaires (including Hip and Groin Outcome Score) and had clinical assessments (including palpation and squeeze tests) and radiographic imaging. Skeletal maturity was graded using the Maturing Adolescent Pubic Symphysis (MAPS) classification. Five radiographic pubic symphysis findings were evaluated using the Aspetar protocol. Players were classified as having groin complaints if player-reported complaints and positive clinical findings from the symphyseal and/or adductor region were present. RESULTS: MAPS stages increased with age. In 23% (7 of 30) of otherwise skeletally mature players, the pubic symphysis was immature, including players up to age 27 years. Sixty-nine (69%) players had 1 or more radiographic findings. The most prevalent findings were bony proliferations (49%) and sclerosis (47%). Fifteen of the 100 players had groin complaints. No differences were found in number or type of radiographic findings in those with and without groin complaints. Fifty-eight players (68% of 85) without complaints (vs. 11 [73% of 15] with complaints) had at least one Aspetar protocol finding. CONCLUSION: Radiographic findings of the pubic symphysis were common in female football players and appeared irrespective of groin complaints. Nearly one quarter of otherwise skeletally mature young adult players were not fully mature at the pubic symphysis. J Orthop Sports Phys Ther 2026;56(7):448-455. Epub 4 May 2026. doi:10.2519/jospt.2026.13580.