Surgical Technique: Reconstruction of Pubic Symphysis

Pubic symphysis instability is an uncommon cause of hip or groin pain. This situation is observed mostly in patients with history of rheumatologic, obstetric, or urologic conditions and athletes with history of repetitive overuse hip, groin, pelvis, core, or spine injury. Traumatic separation of the joint can happen in females due to stretch or rupture of ligamentous structures during birth. Individuals with hypermobility syndromes (such as Ehlers-Danlos Syndrome) are at elevated risk of symphysis instability. Athletes may be at higher risk of developing symptomatic symphysis instability in the setting of core muscle injury. Osteitis pubis is a more common condition which can cause similar symptoms. Even without known risk factors, many patients may present with symptomatic pubic symphysis instability. Symptoms are usually nonspecific and canmimic other pathologies in this area. Thus, diagnosis relies on assimilating the patient’s subjective complaints, objective physical examination, and relevant imaging. Pain during sports activity and weight-bearing along with tenderness over the symphysis and adductor origin are themost common clinical findings. Weight-bearing plain radiographs, especially single-leg stance “flamingo” views, are usually diagnostic. Nonoperative treatment includes oral nonsteroidal antiinflammatory medications, rest, activity modification, and physical therapy. Diagnostic and therapeutic injections may be utilized in the evaluation and treatment of patients with symptomatic symphysis instability before considering surgical reconstruction. Surgical intervention may be indicated if nonoperative treatment fails. Limited literature exists on specific techniques and post-operative outcomes. As with most hip preservation surgery, optimal patient selection, expectation management, and safe open, laparoscopic, or endoscopic techniques are critical to obtain optimal outcomes. Consultation with general surgery and/or urology is valuable to assist in the decision to surgically manage the condition.