Traumatic osteitis pubis: the gracilis syndrome

The "gracilis syndrome," a fatigue fracture of traumatic etiology involving the bony origin of the gracilis muscle at the pubic symphysis, is akin to traumatic osteitis pubis and injuries of the adductor longus muscle origin. It is a well-recognized and reported injury in European athletes, but has received less attention in North America. This paper describes a case of this syndrome in a 23-year-old male athlete with a 2-year history of groin, perineal and medial thigh pain, of gradual onset, associated with his participation in rather violent contact sports. The only positive finding on examination was the belated appearance of local tenderness over the symphysis pubis. Radiographically, a bony fragment, including the inferior corner of his left pubis at the symphysis, could be identified. This lesion was surgically excised, and the patient was relieved of his symptoms. The histopathological features of the fragment revealed both viable and nonviable bony trabeculae embedded in fibrous tissue, suggesting that the lesion is an avulsion type of fatigue fracture with the avulsion related to the directional pull of the gracilis muscle.