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Thigh compartments11/29/2023 One of the most common surgical approaches in orthopedics involving the anterior compartment of the thigh is the lateral approach to the femur. Identifying the correct nerves when performing peripheral nerve blocks is essential. Thorough knowledge of regional anatomy is crucial to operating safely, avoiding neurovascular injury, and correctly identifying intermuscular planes in the region. Knowledge of anatomy allows the surgeon to find the area of the pathology, and understanding of the origins and insertions of the muscles helps to find a tendinous portion appropriate for graft reconstruction. Its floor is also muscular, with the adductor longus occupying the upper part of the floor and the adductor magnus occupying the floor below it. It is roofed by a fascial layer on which the sartorius lies, and the medial and lateral walls are defined by the adductor muscles and the vastus medialis, respectively. The adductor canal is an important anatomical space of the anterior thigh region because it is a neurovascular conduit carrying the femoral artery, femoral vein, saphenous nerve, and the nerve to vastus medialis. The psoas major is innervated by the short collateral branches of the lumbar plexus (L1-元), while the femoral nerve (L1-L4) innervates the iliacus muscle. Both muscles insert onto the lesser trochanter of the femur. The psoas major originates in the lumbar vertebrae, and the iliacus originates from the iliac fossa of the pelvis. The iliopsoas consists of two muscles: the psoas major and the iliacus. The iliopsoas muscle does not cross the knee joint and is responsible for flexion of the thigh and lateral rotation of the hip. The pectineus muscle originates at the pectineal line of the pubis and inserts at the posterior aspect of the femur, immediately inferior to the lesser trochanter. The pectineus is considered a transitional muscle between the anterior and medial thigh this is due to innervation mainly from the femoral nerve and sometimes from the obturator nerve. The pectineus muscle is responsible for flexion, adduction, and medial rotation of the hip. The pectineus forms the base of the femoral triangle and is flat and quadrangular in shape. The sartorius originates from the ASIS and inserts at the superior, medial surface of the tibia, and it is innervated by the femoral nerve. The sartorius muscle is responsible for flexion of the knee and flexion and lateral rotation of the hip joint and is the longest muscle in the body. It is positioned more superficially in the leg than the other muscles in the anterior thigh the long parallel fibers run anteriorly from lateral to medial over the quadriceps. The two heads converge to join as the anterior part of the quadriceps femoris tendon. The rectus femoris is comprised of two proximal heads: the straight head, originating at the anterior inferior iliac spine (ASIS) of the ilium, and the reflected head, originating from a groove superior to the acetabulum. It inserts at the lateral border of the patella, forming the deep portion of the quadriceps tendon. The vastus intermedius originates at the anterior and lateral surfaces of the femoral shaft. It inserts at the medial base and border of the patella, forming the medial patellar retinaculum and the medial side of the quadriceps femoris tendon. The vastus medialis originates at the inferior portion of the intertrochanteric line and medial lip of the linea aspera. It originates from the greater trochanter and lateral lip of linea aspera and inserts at the lateral base and border of the patella, forming the lateral patellar retinaculum and the lateral side of the quadriceps femoris tendon. The vastus lateralis is the largest of the four muscles. The rectus femoris is responsible for thigh flexion at the hip and knee extension. It receives innervation by the femoral nerve. The vastus muscles are responsible for knee extension and stabilization of the patella. The quadriceps femoris connects to the patella via the quadriceps tendon, which then extends to insert at the tuberosity of the tibia. This group is the primary extensor of the knee. The quadriceps femoris is a group of four muscles: vastus medialis, vastus lateralis, vastus intermedius, and rectus femoris. Additionally, the end of the iliopsoas muscle passes through the anterior compartment. Three major muscles (better described as two muscles and one muscle group) comprise the anterior compartment of the thigh - the pectineus, sartorius, and quadriceps femoris. The function of the anterior compartment of the thigh is to extend the leg at the knee joint.
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