Beyond the Groin: Decoding the Pyramidalis–Anterior Pubic Ligament–Adductor Longus Complex Injury Classification

Purpose or Learning Objective: (1) To delineate the radiologic anatomy and biomechanical significance of the pyramidalis–anterior pubic ligament–adductor longus complex. (2) To characterize the radiologic patterns of injuries related to the pyramidalis–anterior pubic ligament–adductor longus complex and available classification systems. (3) To analyze the role of imaging in guiding treatment decisions and return-to-play outcomes.

Methods or Background: The pyramidalis is the only abdominal muscle located in front of the pubic bone. It originates from the pubic crest and anterior pubic ligament, inserting into the linea alba. Injuries to the adductor longus are seldom isolated and typically part of a broader injury involving the pyramidalis–anterior pubic ligament–adductor longus complex. The injury mechanism generally involves a noncontact eccentric force that pushes the hip into abduction and extension. Groin pain is prevalent among athletes in sports that demand rapid cutting, pivoting, or kicking, such as soccer and ice hockey. Athletic pubalgia is increasingly recognized as a common source of chronic groin and adductor discomfort.

Results or Findings: The pyramidalis–anterior pubic ligament–adductor longus complex injuries are classified into six subtypes, all involving fibrocartilaginous avulsion. Further subdivisions are based on the relationship between the pyramidalis and adductor longus. Various examples are presented to highlight the crucial role of magnetic resonance imaging in accurate diagnosis and effective patient management. Other groin injury classifications exist, such as the Doha classification, that does not fully encompass the pyramidalis–anterior pubic ligament–adductor longus complex in detail. Accurately identifying and diagnosing this intricate injury is essential for guiding patient treatment and expediting a return to play.

Conclusion: The proximal adductor longus is an integral part of the pyramidalis–anterior pubic ligament–adductor longus complex and rarely injured in isolation. Referring to these injuries as pyramidalis–anterior pubic ligament–adductor longus complex injuries better captures their complexity. A thorough understanding of the anatomy and its related findings is crucial for diagnosing and treating these multifaceted injuries accurately.

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Artikel online veröffentlicht:
02. Juni 2025