The Genitofemoral Nerve Is the Structure Closest to the Tendon Footprint and Is Most at Risk for Iatrogenic Injury During Proximal Adductor Longus Repair: A Cadaveric Anatomy Study

PurposeTo identify structures at risk during proximal adductor longus repair and to report observed distances between these structures and the adductor longus (AL) footprint.MethodsEight hemipelves from fresh cadaver whole body specimens were dissected using a previously established surgical approach. The tendinous attachment of the AL was scored into the underlying bone and the footprint size was measured in millimeters (mm). A guidewire was placed at the footprint center along the longitudinal axis of the resected AL muscle. Utilizing a digital caliper, the proximity of key anatomical structures was measured as the radial distance from the guidewire and distance distal to the footprint along the guidewire axis.ResultsThe AL footprint was on average 16.95±3.02mm wide by 9.36±1.66mm high. The ilioinguinal nerve was 27.10±7.25mm distal to the AL footprint and 31.75 ± 7.51mm medial with a resulting mean surface area of 158.12±39.90, [110.9-230.2] mm2. The genital branch of the genitofemoral nerve was found 7.79±4.05mm proximal and 15.37±4.54mm medial. The round ligament (N=6) was 14.00±2.75mm and the spermatic cord (N=2) was 13.57±3.02mm directly superficial to AL footprint. The obturator nerve was 63.98±4.57mm distal as it crossed the adductor brevis muscle laterally. The location of the external pudendal artery was variable but was found to have a mean distance of 37.01±17.97mm distal and immediately deep to the AL.ConclusionsWhen repairing AL tendon injuries, the genitofemoral nerve is the structure anatomically nearest the footprint of the tendon, and this structure most at risk for iatrogenic injury.Clinical relevanceThis study investigates the structures at risk during AL repair and seeks to define their location relative to the footprint. These findings will assist surgeons in identifying the crucial anatomic structures at risk to safely perform an anatomic repair of the tendon and avoid iatrogenic complications.