Classification and Localization of the Adductor Hiatus: A Cadaver Study

Abstract

Objective: To determine not only the vertical but also horizontal localization of the adductor hiatus (AH) and classify its shape and structure macroscopically. Material and Methods: Forty lower extremities were dissected to expose the AH. Its shape and structure were macroscopically noted, and the AH was classified into four types. For determining the localization, measurements were made with digital calipers. Results: Twenty-four oval fibrous types, 12 oval muscular types, 2 bridging fibrous types and 2 bridging muscular types of AH were determined. For the horizontal localization of AH, the apex of the AH was determined to be located medial to the vertical line between the midpoint of the interepicondylar distance and the line which was drawn transversely from the apex of the AH, in all of the cadavers. For the vertical one, the apex of the AH was located in the middle third of the femur length in 14 thighs, and in the remaining 26 ones, the apex of the AH was located in the distal third of the femur length. Conclusion: Adductor hiatus was classified according to its shape and structure for the first time. Moreover, the localization of the AH was practically defined, in order not to harm the popliteal artery and vein. Turkish Başlık: Hiatus Adductorius'un Konumunun Belirlenmesi Ve Sınıflanması: Bir Kadavra Çalışması Anahtar Kelimeler: Hiatus adductorius, adduktor kanal çıkım sendromu, femaoropopliteal oklüzyon, musculus adductor magnus Amaç: Hiatus adductorius'un (AH) şeklini ve yapısını makroskopik olarak sınıflamak ve sadece dikey değil yatay konumunu da belirlemek. Gereç ve Yöntem: AH'yi incelemek için 40 alt ekstremite disseke edildi. AH'nin şekli ve yapısı makroskopik olarak değerlendirildi ve 4 tip altında sınıflandırıldı. AH'nin konumunu belirlemek için dijital bir kaliper ile ölçümler yapıldı. Bulgular: Yirmidört uylukta oval fibröz, 12 uylukta oval müsküler, 2 uylukta köprüleşen fibröz ve 2 uylukta köprüleşen müsküler tip AH gözlemlendi. AH'nin horizontal konumuna bakıldığında; AH'nin apeksinin, tüm kadavralarda, interepikondiler uzaklığın orta noktasından, AH'nin apeksinden geçen transvers çizgiye çıkılan dikmenin, iç yanında yerleştiği gözlemlendi. Dikey konum için ise, AH'nin apeksinin 14 uylukta femur boyunun orta 1/3'ünde, geri kalan 26 uylukta da distal 1/3'ünde yerleştiği görüldü. Sonuç: AH şekil ve yapısına göre ilk defa sınıflandırıldı. Arteria ve vena poplitea'ya verilebilecek zararı en aza indirmek için, AH yerleşimi pratik olarak tanımlandı.

Keywords

• Adductor hiatus, adductor canal outlet syndrome, femoropopliteal occlusion, adductor magnus muscle

Classification and Localization of the Adductor Hiatus: A Cadaver Study

Öz

Kaynakça

1. Moore KL, Dalley AF. Clinically oriented Anatomy. Lippincott Williams & Wilkins. 4th edition. 1999.pp.541.
2. Standring S, editor. Gray’s Anatomy. Spain: Churchill Livingstone. 39th edition. 2005.pp.1466.
3. McMillan DE. Blood flow and the localization of atherosclerotic plaques. Stroke 1985;16:582-7. [CrossRef]
4. Lindblom A. Arteriosclerosis and arterial thrombosis in the lower limb. Acta Radiol 1950;80:1-80.
5. Scholten FG, Mali WP, Hilen B, van Leeuwen MS. US location of the adductor canal hiatus: a morphologic study. Radiology 1989;172:75-8.
6. Scholten FG, Warnars GA, Mali WP, van Leeuwen MS. Femoropopliteal occlusions and the adductor canal hiatus, Duplex study. Eur J Vasc Surg 1993;7:680-3. [CrossRef]
7. Watt JK. Origin of femoro-popliteal regions. Br Med J 1965;2:1455-9. [CrossRef]
8. Wensing PJW, Scholten FG, Buijs PC, Hartkamp MJ, Mali WPTM, Hillen B. Arterial tortuosity in the femoropopliteal region during knee flexion: a magnetic resonance angiographic study. J Anat 1995;186:133-9.

9. Wensing PJW, Meiss L, Mali WPTM, Hillen B. Early atherosclerotic lesions spiraling through the femoral artery. Arterioscler Thromb Vasc Biol 1998;18:1554-8. [CrossRef]
10. Dunlop GR, Dos Santos R. Adductor canal thrombosis N Eng J Med 1957;256:557-80.
11. Palma EC. Hemodynamic arteriopathy. Angiology 1959;10:134-43. [CrossRef]
12. Balaji MR, DeWeese JA. Adductor canal outlet syndrome. JAMA 1981;245:167-70. [CrossRef]
13. The SH, Wilson RA, Gussenhoven EJ, Pieterman H, Bom K, Roelandt JR, et al. Extrinsic compression of the superficial femoral artery at the adductor canal: evaluation with intravascular sonography. AJR Am J Roentgenol 1992;159:117-20.
14. Tubbs RS, Loukas M, Shoja MM, Apaydin N, Oakes WJ, Salter EG. Anatomy and potential clinical significance of the vastoadductor membrane. Surg Radiol Anat 2007;29:569-73. [CrossRef]
15. Abela GS. Peripheral vascular disease: Basic diagnostic and therapeutic approaches. Lippincott Williams & Wilkins. 1st edition.2004.pp.100-1.
16. Cohn SL, Taylor WC. Vascular problems of the lower extremity in athletes. Clin Sports Med 1990;9:449-70.
17. Biemans RG, van Bockel JH. Popliteal artery entrapment syndrome. Surg Gynecol Obstet 1977;144:604-9.
18. Checroun AJ, Mekhail AO, Ebraheim NA, Jackson WT, Yeasting RA. Extensile medial approach to the femur. J Orthop Trauma 1996;10:481-6. [CrossRef]
19. Olson SA, Holt BT. Anatomy of the medial distal femur: a study of the adductor hiatus. J Orthop Trauma 1995;9:63-5. [CrossRef]
20. Scheibel MT, Schmidt W, Thomas M, von Salis-Soglio G. A detailed anatomical description of the subvastus region and its clinical relevance for the subvastus approach in total knee arthroplasty. Surg Radiol Anat 2002;24:6-12. [CrossRef]