Adductor canal syndrome

Last revised by Yahya Baba on 21 Dec 2020

Adductor canal syndrome (also known as adductor canal compression syndrome) is a rare, non-atherosclerotic cause of arterial occlusion and limb ischemia 1. There is compression of the superficial femoral artery (SFA) in the adductor canal.

External compression of the superficial femoral artery in the absence of atherosclerotic risk factors causing adductor canal syndrome is rare and available data is limited to case reports 1. The syndrome is most commonly reported in young males less than 45 years old 2.

The presentation can vary depending on the severity of the occlusion. The most severe present with symptoms of acute limb ischemia 1. Compression of the saphenous nerve without vascular involvement can cause pain over the medial aspect of the knee. Symptoms include 2:

  • exercise-induced claudication
  • paresthesia
  • pain
  • edema (due to femoral vein compression)
  • pallor
  • poikilothermia
  • thrombosis leading to acute limb ischemia

There is chronic external compression of the superficial femoral artery as it courses through the adductor canal 1. This results in injury to the vessel, in situ thrombosis, limb ischemia, and potential limb loss 3,4. The sources of external compression may arise from either an anomalous musculotendinous band arising from the adductor magnus or hypertrophy of the adductor magnus or vastus medialis muscles 2,3,5.

Treatment is always surgical and involves resection or release of the external compressive forces 1. Angioplasty or bypass of the diseased superficial femoral artery may be required if the mechanical compression has caused vascular damage. Acute limb ischemia due to thrombosis from adductor canal syndrome requires immediate revascularization either via endovascular thrombolysis or thromboembolectomy 1. Diagnosis of adductor canal syndrome should prompt investigation for the same condition on the contralateral side 6.

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