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Anatomical study of the adductor canal: three-dimensional micro-computed tomography, histological, and immunofluorescence findings relevant to neural blockade

 Shin Hyo Lee  ;  Hee Jung Kim  ;  Shin Hyung Kim  ;  Tae-Hyeon Cho  ;  Hyun-Jin Kwon  ;  Jehoon O  ;  Ju Eun Hong  ;  Seung Hyun Nam  ;  Young-Il Hwang  ;  Hun-Mu Yang 
 KOREAN JOURNAL OF ANESTHESIOLOGY, Vol.76(3) : 252-260, 2023-06 
Journal Title
Issue Date
Fascia ; Fluorescent Antibody Technique ; Humans ; Muscle, Skeletal* / anatomy & histology ; Muscle, Skeletal* / diagnostic imaging ; Thigh* / innervation ; X-Ray Microtomography
Anatomy ; Anesthesia ; Cadaver ; Fascia ; Histology ; Immunohistochemistry
Background: A precise anatomical understanding of the adductor canal (AC) and its neural components is essential for discerning the action mechanism of the AC block. We therefore aimed to clarify the detailed anatomy of the AC using micro-computed tomography (micro-CT), histological evaluation, and immunofluorescence (IF) assays.

Methods: Gross dissections of 39 thighs provided morphometric data relevant to injection landmarks. Serial sectional images of the AC were defined using micro-CT and ultrasonography. The fascial and neural structures of the AC proper were histologically evaluated using Masson's trichrome and Verhoeff-Van Gieson staining, and double IF staining using choline acetyltransferase (ChAT) and neurofilament 200 antibodies.

Results: The posteromedial branch insertion of the nerve to vastus medialis (NVM) into the lateral border of the AC proper was lower (14.5 ± 2.4 cm [mean ± SD] above the base of the patella) than the origin of the proximal AC. The AC consists of a thin subsartorial fascia in the proximal region and a thick aponeurosis-like vastoadductor membrane in the distal region. In the proximal AC, the posteromedial branch of the NVM (pmNVM) consistently contained both sensory and motor fibers, and more ChAT-positive fibers were observed than in the saphenous nerve (27.5 ± 11.2 / 104 vs. 4.2 ± 2.6 / 104 [counts/µm2], P < 0.001).

Conclusions: Anatomical differences in fascial structures between the proximal and distal AC and a mixed neural component of the neighboring pmNVM have been visualized using micro-CT images, histological evaluation, and IF assays.
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1. College of Medicine (의과대학) > Dept. of Anatomy (해부학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Shin Hyung(김신형) ORCID logo https://orcid.org/0000-0003-4058-7697
Kim, Hee-Jung(김희정) ORCID logo https://orcid.org/0000-0002-2143-3943
Yang, Hun Mu(양헌무) ORCID logo https://orcid.org/0000-0003-1954-0114
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