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Prepubic aponeurotic complex injuries: a structured narrative review
Andrea Bisciotti1, Gian N Bisciotti2,3, Cristiano Eirale3
1IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Insights
The prepubic aponeurotic complex (PPAC) is a key anatomical structure. Understanding its anatomy, imaging, and treatment is crucial for differentiating PPAC injuries from adductor longus injuries.
Area of Science:
- Anatomy
- Radiology
- Sports Medicine
Background:
- The prepubic aponeurotic complex (PPAC) is an anatomical structure crucial for pelvic stability.
- Its complex composition can lead to diagnostic challenges, often mimicking adductor longus tendon injuries.
Purpose of the Study:
- To provide a comprehensive review of the prepubic aponeurotic complex (PPAC).
- To elucidate the anatomy, clinical presentation, imaging characteristics, and treatment options for PPAC injuries.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed/MEDLINE, Scopus, ISI, EXCERPTA).
- Inclusion of original articles, case series, and review articles without language or publication date restrictions.
Main Results:
- The PPAC is formed by the confluence of multiple muscles, ligaments, and periosteum.
- PPAC injuries present clinically similar to adductor longus injuries, necessitating advanced imaging like MRI for differentiation.
- Typical MRI findings aid in distinguishing PPAC injuries from other conditions.
Conclusions:
- Accurate diagnosis of PPAC injuries relies on understanding its anatomy and characteristic MRI findings.
- Treatment for PPAC injuries can be conservative (medical therapies) or surgical.
- This review offers valuable insights for clinicians managing PPAC-related conditions.
Abstract:
The prepubic aponeurotic complex anatomy (PPAC) consists in a fibrous capsule, which anteriorly lines the pubic symphysis, formed by the interconnection of different anatomical structures. Research of the studies (original articles, case series and review articles) was conducted without publication data limitation or language restriction on the following databases: PubMed/MEDLINE, Scopus, ISI, EXCERPTA. To date, evidence from the literature suggests that: 1) the PPAC is formed by interconnection between the tendons of the adductor longus, adductor brevis, gracilis and pectineus muscles, the aponeurosis of rectus abdominis, pyramidalis and external oblique muscles, the articular disc, the anterior pubic periostium and by the superior, inferior and anterior pubic ligament; 2) the PPAC clinical presentation may mimic a adductor longus tendon injury, the MRI examination can help to differentiate the two different clinical frameworks; 3) the PPAC injuries show a typical MRI presentation which must be differentiated from other similar but clinically different imaging frameworks; 4) the PACC injury can be treated conservatively, with medical therapies or surgically. This narrative structured review provides an insight into the PPAC the anatomy, the clinical presentation, the imaging and the treatment of the PPAC injuries.
