PLAC lesion or injury

A PLAC lesion or injury (Pyramidalis, Ligamentum anterior pubis, Adductor longus Complex injury) is a tear in the adductor muscles (muscles on the inside of the thigh) that can also extend into the abdominal muscles. This tear can develop gradually or suddenly (traumatically).

There are different types, depending on the extent of the tear in the adductor muscles and how far it extends into the abdominal muscles.

This condition is often misdiagnosed as 'pubalgia'. However, pubalgia means pain in the pubic bone (os pubis) and is not a specific diagnosis. Pubalgia also includes other conditions such as overuse of the abdominal muscles, adductor muscles, as well as specifically a tear (PLAC lesion).

A PLAC lesion is not easy to diagnose because it requires a very specific medical imaging protocol.

How does a PLAC lesion occur?

A PLAC lesion can develop either gradually or acutely. An acute injury typically occurs when kicking a ball, sprinting or slipping (where the leg slides outwards). In overuse injuries (inflammation of the adductor attachments) that do not heal sufficiently, the affected overloaded tissue can eventually tear.

The tissue's load capacity (i.e., how strong the tendon is) also determines whether an injury can occur. If the load is higher than the load capacity, the risk of injury is higher.

You can compare this to an elastic band: if you take a weak elastic band (tendon) and apply a lot of force (load) to it, it can break (tear). It will break faster if you pull it explosively and hard, but it can also become less elastic (load capacity) if it is subjected to high loads for a long period.

A PLAC lesion typically causes groin pain at the pubic bone, where the adductor muscles attach. This can radiate to the inside of the thigh. Often, it spreads to the other side. Sometimes the pain can extend upwards, following the course of the abdominal muscles.

It is important to distinguish this from an inguinal hernia. This can also cause pain in the pubic bone area but typically causes discomfort slightly higher than the groin region. It can radiate to the pubic bone, abdominal muscles, and even the testicle. This often causes typical discomfort when coughing, sneezing, and straining. This is not typical for a PLAC lesion.

A PLAC lesion typically causes pain in the pubic bone area when:

• Pushing the thigh inwards
• Pushing both straight legs together inwards, especially when tensing the abdominal muscles
• Getting up from a lying position (e.g., getting out of bed)
• Sports with explosive movements such as football and sprinting
• Deep bending movements such as putting on and taking off shoes

Treatment depends on the severity of the injury. There are 6 types of PLAC lesions. Depending on the symptoms and imaging, treatment will consist of:

• Specific exercise therapy
• Injection
• Surgery: PLAC repair

We will discuss with you which treatment option is most suitable based on your specific situation and needs.