ePoster #300 - ISHA Annual Scientific Meeting 2016

Three-Dimensional Surface Mapping Of The Neuromuscular Attachments At The Pubic Symphysis: Implications For The Treatment Of Symphyseal Tendinopathy

Benjamin Kuhns, MD, Chicago, IL UNITED STATES
Alexander Weber, MD, Chicago, IL UNITED STATES
Kevin Campbell, MD, Chicago, IL UNITED STATES
Struan H. Coleman, MD, PhD, New York, NY UNITED STATES
William C. Meyers, MD, MBA, Philadelphia, PA UNITED STATES
Shane J. Nho, MD, MS, Chicago, IL UNITED STATES
Gift C. Ukwuani, MD, Chicago, IL UNITED STATES

Rush University Medical Center, Chicago, Illinois, UNITED STATES

FDA Status Not Applicable

Summary: We present a 3D topographic mapping study of the muscular attachments about the pubic symphysis with relevance towards athletic pubalgia and adductor related groin pain.

Abstract:
Introduction:
Techniques have recently been developed to endoscopically manage pathology of the pubic symphysis and adjacent musculature including core muscle injuries and osteitis pubis. Currently, the precise anatomy of this region remains poorly understood by the orthopedic community. The purpose of this study was to determine the anatomy of the neuromuscular structures about the pubic symphysis.

Methods:
Two fresh-frozen cadaveric pelvises (a total of four dissections) were used for this pilot study. An additional six will be added by the time of abstract presentation. The anatomic region adjacent to the pubic symphysis was meticulously dissected in each hemipelvis. The initial anatomic landmarks of interest included the musculotendinous insertion of the rectus abdominis and origins of the adductor longus, adductor brevis, and the insertion of the inguinal ligament. The footprints of these structures were outlined and measured with a three-dimensional (3D) coordinate measuring system (MicroScribe, Amherst Va). The attachments were removed to expose the pectineus, and gracilis, which were outlined and measured. Once all structures were removed, the cartilage plate was outlined and measured. Footprint cross-sectional area and distances between structures were calculated using data acquisition software (Rhinoceros 3D v5.0, Seattle Wa). The coefficient of variation (CV) was used to assess variability in footprint area and distances between anatomic structures.

Results:
Both bilateral specimens were male with an average age of 62 ± 2 years. The average footprints of the rectus femoris, inguinal ligament, adductor longus and adductor brevis were 8.21 ± 3.1 cm2, 1.64 ± 0.5 cm2, 3.14 ± 0.35 cm2 and 3.08 ± 0.11 cm2, respectively. The adductor brevis and longus insertions were closest together with an average distance of 14.9 ± 2.5mm, while the adductor longus and rectus distance was 27.9 ± 3.6mm. The average pectineus and gracilis footprints were 7.01 ± 0.54 cm2 and 4.76 ± 0.85 cm2, respectively. The area of the entire cartilage plate had an average cross-sectional area of 24.8 ±5.6 cm2. The pectineus and gracilis had thin yet fan-like attachments whereas the adductor longus and brevis had thicker origins. The highest variability in anatomic position was seen for the distance between the adductor longus and brevis insertions (0.81) and the distance between the adductor longus and inguinal ligament (0.54).

Conclusion:
Indications for surgical procedures adjacent to the pubic symphysis continue to expand as knowledge of symphyseal pathology improves. However, in order to best treat these pathologies it is prudent to have a firm understanding of the normal anatomy and the relationships to adjacent neuromuscular structures. This study is one of the first to describe the native anatomy and the anatomic relationships pertinent to the orthopaedic surgeon.