PUBIC PLATE INJURY OSTEITIS PUBIS
The pubic symphysis is a syndesmotic joint comprising fibrocartilage with a central fluid filled space which contains a meniscal disc
It is inherently unstable
It is supported by a fibrocartilaginous pubic plate which lies deep to extensions of the abdominal wall aponeurosis. Extensions of the external oblique fascia criss-cross the anterior aspect of the pubic symphysis and plate
providing connections with the common adductor tendon
Rectus abdominis muscle attaches to the superior aspect of the pubic bones
A smaller Pyramidalis muscle crosses over the anterior aspect of the pubis with attachments to the pubic bone and adjacent fascia
The inherent instability at the pubic symphysis leads to micro movement resulting in fissuring of the fibrotic margins of the joint and development of subchondral oedema within the pubic bone
These features are often termed osteitis pubis
They are not necessarily a cause of symptoms and similar changes around the pubic symphysis are frequently identified in asymptomatic footballers
As stress around the pubic symphysis progresses tears can develop in the anteroinferior margins of the pubic plate
In the past these have been referred to as secondary clefts
Occasionally they extend laterally to undercut the common adductor tendon attachment
Enthesopathy may develop at the common adductor attachment with traction changes in the underlying bone
These are frequently asymptomatic
Myotendinous junction tears can also occur more distally in the complex
Tears are also reported in the obturator externis, adductor brevis and gracilis muscles