Perivascular adductor longus muscle injury

Last revised by Daniel J Bell on 24 Apr 2022

A perivascular adductor longus muscle injury is an infrequent type of trauma to the adductor longus muscle, which is poorly and infrequently reported in the literature 1-3, and may as a result remain underdiagnosed and undertreated.

The adductor longus muscle originates from the external surface of the body of the pubis, and inserts at the linea aspera on the medial aspect of the middle third of the shaft of the femur.

Most adductor longus muscle injuries occur at its origin, and present as acute pubic or groin pain in athletes 1-3.

In the mid-thigh, as the adductor longus approaches its insertion, it is closely related to the neurovascular bundle (including the femoral artery and vein), which lies between adductor longus laterally, vastus medialis medially, and sartorius superiorly. Perivascular adductor longus muscle injuries occur at this site.

These injuries are often difficult to identify on ultrasound, as the lesion lies very close to the femoral vessels and increased echogenicity in the muscle can be misinterpreted because of posterior acoustic enhancement from the vessels. Applying pressure with the ultrasound probe can allow clearer visualization of the muscle by moving the neurovascular bundle out of the way of the beam 4.

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

Fat-suppressed fluid-sensitive sequences, such as STIR, are the most useful for identifying intramuscular edema and a perifascial fluid collection. The presence of signal change between the adductor longus and the vastus medialis muscles suggests a perivascular type of injury 4.

An MRI grading scheme has been proposed for perivascular adductor longus muscle injury in the first 72 hours:

  • grade 1: altered signal of the lateral fascial aspects of the adductor longus
  • grade 2: altered signal of the lateral muscle fibers
  • grade 3: the presence of interfascial fluid, even detectable distally to the lesion

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

The vast majority of perivascular adductor longus muscle injuries are managed conservatively.

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