Perivascular adductor longus muscle injury

Adductor longus muscle injury which is created by an indirect trauma mostly affects the proximal myotendinous junction and enthesis which is focused in literature ^1-3.

However, despite the fact, there are other types of adductor longus muscle injuries, caused by indirect trauma, which is poorly and infrequently reported in literature ^1-3. Considering this fact, theyperivascular adductor longus muscle injury may remain commonly underdiagnosed and therefore left untreated or inadequately treated.

Location

Regarding the transverse sections, the neurovascular bundle including the femoral artery/vein and saphenous nerve (as the final branch of the femoral nerve) is located superolateral to the muscle. Moreover sartorius muscle act as a roof to the neurovascular bundle.

Inferolateral to the muscle, the deep femoral vessels, and the obturator nerve are seen that perivascular adductor longus muscle injury is happened at this site or at the anatomical region located between the superficial and the deep femoral vessels.

Radiographic features

Ultrasound

Misdiagnosis of the isolated perivascular adductor longus muscle injury during US examination is a distinct possibility, especially in the first seventy-two hours post-trauma, as the lesion is placed very close to the femoral vessels and misinterpreted because of posterior acoustic enhancement artifact-related issues.

MRI

MRI is considered the gold standard to accurately identify the site of injury (myofascial, myotendinous junction, intra tendinous, or a combination of these) that is clinically and ultrasonographically suspected.

In the T2WI axial sequence the presence of moderate signal alteration, mimics a pseudo-thickening of the lateral fascial aspects, making it possible to locate the site of injury. But Fat-suppressed fluid-sensitive technique such as STIR sequence is the most useful for intramuscular oedema and perifascial fluid collection. The presence of signal change between the adductor longus and the vastus medialis suggests the perivascular type of injury ⁴.

A magnetic resonance imaging grading scheme proposed for perivascular Adductor Longusadductor longus muscle injury in the first seventy-two hours:

·        grade 1: altered signal of the lateral fascial aspects of the adductor longus

·        grade 2: altered signal of the lateral muscle fibres

·        grade 3: the presence of inter-fascial liquid infiltrations, even detectable distally to the lesion

Radiology report

The radiological report should include a description of the following:

• location, type, and extent of the lesion
• injury grading if possible
• the extent of tendon retraction
• associated injuries

Treatment and prognosis

The vast majority of muscle injuries are managed conservatively. So, the diagnosis of the isolated perivascular adductor longus muscle injury and assessment of its extension is necessary to identify the prognosis, making a rehabilitation protocol in order to adjust the healing process and reduce the recurrence risk ⁴.