The Use of Botulinum Toxin in Pre-Pubic Aponeurotic Complex Injuries: A Case Report.

The pre-pubic aponeurotic complex (PPAC) is a fibrous capsule which lines the anterior of the pubic symphysis. The PPAC may be injured during pelvic torsional movements and single-stance maneuvers. This case report describes a PPAC lesion in a 23-year-old professional male athlete specializing in decathlon on a national level. The lesion was treated with US-guided infiltration therapy with botulinum toxin (BTX) and platelet-rich plasma therapy (PRPt) to the longus adductor (LA) and rectus abdominis (RA) muscles. The magnetic resonance imaging control performed at 24 weeks after BTX infiltration and PRPt showed a total restitution ad integrum of the lesion area. At a 3-year follow-up, the subject no longer complained of pain and was restored to his pre-injury level of sport. The distention of LA and RA obtained by BTX infiltration coupled with PRPt allowed PPAC to heal. The BTX infiltrative therapy coupled with PRPt may represent a new and promising treatment for PPAC lesions.

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