Surgical Treatment of Pubic Symphysis Instability Using Semitendinosus Tendon Grafts: A Two-Case Report with Surgical Technique Description

The pubic symphysis is a key joint for the stability of the pelvic ring. Pubic symphysis instability may lead to chronic pain and significant functional limitation, particularly in athletes and young subjects. Although conservative management is the first-line approach, refractory cases may require surgical intervention. The present study aimed to describe a surgical technique used in two soccer players who underwent pubic symphysis reconstruction through a Pfannenstiel approach with an autologous semitendinosus tendon graft passed through bone tunnels in the pubic bones in a figure- eight configuration and fixed with non-absorbable sutures. This technique's goal is to preserve the physiological mobility of the pubic symphysis. At 6 months, both patients showed an improvement of more than 30 points in the modified Harris Hip Score. Moreover, they achieved satisfactory functional recovery, returning to sports at 6 and 8 months, respectively. Radiographic evaluation demonstrated improved pelvic stability over a 5-year follow-up period. The technique proved to be safe, with low morbidity, and good clinical outcomes, allowing pelvic mobility preservation and return to sports. Despite the small number of cases, this surgical approach appears to be reproducible, with biomechanical advantages over pubic symphysis arthrodesis and a low complication rate.