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Superior pubic ligament

The superior pubic ligament is a strong fibrous band that reinforces the superior aspect of the pubic symphysis joint. It extends between the pubic bones, spanning the pubic crest and tubercle, and contributes significantly to pelvic stability. It forms the main superior stabilizer of the pubic symphysis, resisting separation and shearing forces during locomotion, childbirth, and load-bearing activities.

This ligament is clinically important in pelvic fractures, pubic symphysis diastasis, and sports-related groin injuries. It can also be visualized on cross-sectional imaging, particularly MRI, where it may show disruption or edema in traumatic or inflammatory conditions.

Synonyms

  • Superior ligament of the pubic symphysis

  • Pubic crest ligament

  • Superior pubic symphyseal ligament

Attachments and Course

  • Attachments: Extends from the pubic crest and pubic tubercle on one side to the corresponding structures on the opposite side

  • Course: Runs horizontally across the upper margin of the pubic symphysis

  • Blends with the anterior pubic ligament and adjacent rectus abdominis and oblique aponeuroses

Relations

  • Superiorly: Rectus abdominis and pyramidalis muscles

  • Inferiorly: Pubic symphysis fibrocartilaginous disc

  • Anteriorly: Aponeurosis of external oblique

  • Posteriorly: Blends with periosteum and adjacent pelvic fascia

Nerve Supply

  • No direct innervation (ligamentous structures have limited sensory innervation via adjacent iliohypogastric and ilioinguinal nerves)

Arterial Supply

  • Branches from the obturator artery

  • Small branches of the inferior epigastric artery

  • Contributions from the pubic branch of the external iliac artery

Venous Drainage

  • Venous outflow follows the arterial supply into the obturator vein and external iliac vein

Function

  • Provides superior reinforcement of the pubic symphysis

  • Resists separation, shear, and vertical displacement of the pubic bones

  • Assists in stabilizing the anterior pelvic ring during gait, load transfer, and childbirth

Clinical Significance

  • Frequently involved in pubic symphysis diastasis during trauma or pregnancy

  • Can be disrupted in pelvic fractures with anterior ring instability

  • May demonstrate edema or partial tears in athletes with chronic groin pain (osteitis pubis)

  • Important landmark in pelvic surgical approaches

MRI Appearance

T1-weighted images:

  • Ligament shows low signal intensity

  • Partial tears may show irregular thickening with focal high signal intensity

T2-weighted images:

  • Normally low signal

  • Injury, inflammation, or edema appear as bright signal intensity

STIR (Short Tau Inversion Recovery):

  • Ligament normally dark

  • Pathological changes such as strain, inflammation, or tear appear bright

Proton Density Fat-Sat (PD FS):

  • Normal ligament remains dark

  • Pathological changes show bright signal, outlining edema or disruption

T1 Fat-Sat Post-Contrast:

  • Mild, uniform enhancement if vascularized repair tissue is present

  • Inflammatory or infectious pathology may show heterogeneous or rim enhancement

CT Appearance

Non-Contrast CT:

  • Appears as a thin, dense fibrous band across the superior pubic symphysis

  • Disruption appears as loss of continuity or diastasis of the joint

  • May show adjacent bony irregularity in trauma or degeneration

Post-Contrast CT:

  • Ligament itself enhances minimally

  • Adjacent inflammatory or infectious changes may enhance irregularly

  • Abscess near the pubic symphysis shows rim enhancement with central low density

MRI image

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MRI image

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CT image

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