High-yield overview
The Tailor's Muscle
L2-L3Roots
LongestSize
FABERAction
RoofRelation
PES ANSERINUS COMPONENTS
Sartorius
PatternMost Anterior/Superficial (Femoral N)
TreatmentAnterior
Gracilis
PatternMiddle (Obturator N)
TreatmentMedial
Semitendinosus
PatternMost Posterior/Deep (Sciatic N)
TreatmentPosterior
Critical Must-Knows
- Originates from the ASIS (Anterior Superior Iliac Spine).
- Inserts onto the Proximal Medial Tibia (Pes Anserinus).
- Longest muscle in the human body.
- Forms the ROOF of the Adductor (Hunter's) Canal.
- Innervated by the Femoral Nerve (L2, L3).
Clinical Pearls
- "The Sartorius is the lateral border of the Femoral Triangle and the medial border of the proximal thigh compartments.
- "It crosses TWO joints (Hip and Knee), acting on both.
- "Pes Anserinus ('Goose's Foot') receives innervation from three different nerves (Femoral, Obturator, Sciatic).
- "The Saphenous Nerve exits the Adductor Canal between the Sartorius and Gracilis.
Surgical Hazards
Saphenous Nerve
Iatrogenic Injury.
- Runs deep to the Sartorius in the Adductor Canal.
- Pierces the fascia lata between Sartorius and Gracilis to become subcutaneous.
- Risk: Identifying the interval incorrectly during hamstring harvest or medial knee approaches can transect the nerve.
- Result: Numbness/Neuroma on medial leg.
Lateral Cutaneous Nerve of Thigh
Origin Relation.
- Passes medial (or sometimes through) the origin of Sartorius at the ASIS.
- Risk: Smith-Petersen approach or ASIS graft harvest.
- Consequence: Meralgia Paresthetica (Lateral thigh numbness).
| Feature | Sartorius | Gracilis | Semitendinosus |
|---|---|---|---|
| Origin | ASIS | Pubis | Ischial Tuberosity |
| Innervation | Femoral (L2/3) | Obturator (L2/3) | Sciatic (Tibial L5/S1/2) |
| Insertion | Pes (Anterior) | Pes (Middle) | Pes (Posterior) |
| Action | Flex/Abd/ER Hip + Flex Knee | Adduct Hip + Flex Knee | Extend Hip + Flex Knee |
Mnemonic
SGTPes Anserinus Order
| S | Sartorius Say (Femoral N) |
| G | Gracilis Grace (Obturator N) |
| T | Semitendinosus Tea (Sciatic N) |
| S | Sartorius Say (Femoral N) |
| G | Gracilis Grace (Obturator N) |
| T | Semitendinosus Tea (Sciatic N) |
Hook:Say Grace before Tea. (Anterior to Posterior).
Mnemonic
FABERAction (Tailor's Position)
| F | Flexion Hip & Knee |
| AB | Abduction Hip |
| ER | External Rotation Hip |
| F | Flexion Hip & Knee |
| AB | Abduction Hip |
| ER | External Rotation Hip |
Hook:The position a tailor sits in (cross-legged).
Mnemonic
SAILFemoral Triangle
| S | Sartorius Lateral Border |
| A | Adductor Longus (Medial Border) |
| IL | Inguinal Ligament (Superior Border) |
| S | Sartorius Lateral Border |
| A | Adductor Longus (Medial Border) |
| IL | Inguinal Ligament (Superior Border) |
Hook:Sartorius sets SAIL for the knee.
Overview
The Sartorius is a unique, strap-like muscle that spirals obliquely across the anterior thigh. It is the longest muscle in the human body, with long parallel fascicles giving it a large excursion but relatively modest force. Its name derives from the Latin sartor (tailor), referencing the cross-legged sitting position (flexion, abduction, external rotation) that tailors traditionally adopted while working.
For the exam candidate, the Sartorius matters far more for its topographical relationships than for its (largely redundant) motor function:
- It is the lateral border of the femoral triangle and the roof of the adductor (subsartorial / Hunter's) canal — making it the surface landmark for the femoral artery and the saphenous nerve.
- Its distal insertion forms the most superficial / anterior limb of the pes anserinus, the site of pes anserine bursitis and the working layer during hamstring (gracilis/semitendinosus) graft harvest.
- Its proximal origin from the ASIS is the apophysis avulsed by sprinting adolescents.
These three "danger and landmark" zones — origin (ASIS), roof of the canal, and pes insertion — are the high-yield core of every Sartorius viva.
Neurovascular
Origin
- ASIS: Anterior Superior Iliac Spine.
- Notch: Also attaches to the upper half of the notch immediately below the ASIS.
Course
- Runs obliquely across the upper and middle thirds of the thigh.
- Moves from Lateral (ASIS) to Medial (Tibia).
- Spirals around the medial aspect of the thigh to reach the posterior aspect of the medial condyle, then curves forward.
Insertion
- Pes Anserinus: Upper part of the medial surface of the tibia.
- Arrangement: Inserts ANTERIOR and SUPERIOR to the Gracilis and Semitendinosus.
- Expansion: Sends an expansion to the capsule of the knee joint and crural fascia.
Surface Anatomy
Palpation
- Origin: Easily palpable at the ASIS.
- Belly: Can be made prominent by asking the patient to lift the heel and cross the legs (FABER position).
- Adductor Canal: The muscle belly is the guide. The pulse of the femoral artery can be felt DEEP to the sartorius in the mid-thigh.
Surgical Marking
- A line from ASIS to the Medial Femoral Condyle approximates the course.
- The upper 1/3 forms the lateral border of the femoral triangle.
- The middle 1/3 covers the Hunter's Canal.
Identifying the medial border of the Sartorius is the key step in the anterior approach to the Femoral Artery.
Classification Systems
Coxa Saltans (Snapping Hip) Classification
Sartorius pathology fits into the external/extra-articular types.
- External Type:
- Iliotibial Band (ITB): Most common. Snaps over Greater Trochanter.
- Gluteus Maximus: Anterior fibers snapping over GT.
- Internal Type:
- Iliopsoas: Snaps over Iliopectineal eminence or femoral head.
- Rare Variants:
- Sartorius: Snapping over the ASIS or AIIS (rare).
- Biceps Femoris: Long head snapping over Ischial Tuberosity.
Although Sartorius snapping is rare, it must be considered in athletes with anterior hip snapping that mimics intra-articular pathology.
Clinical Assessment
FABER Test
Patrick's Test.
- Position: Flexion, Abduction, External Rotation (Figure-4).
- Action: Engages the Sartorius.
- Pain: Anterior groin pain may indicate hip pathology or Iliopsoas/Sartorius strain. Posterior pain indicates SI Joint.
Pes Anserine Palpation
Medial Knee Pain.
- Palpate 2-3cm distal to the medial joint line.
- Tenderness: Suggests Pes Anserine Bursitis.
- Differentiate: Joint line tenderness (Meniscus) vs Tibial tenderness (Stress fracture) vs Pes tenderness (Bursitis).
Muscle Testing
- Resistance: Resisted flexion and external rotation of the hip.
- Grading: MRC Scale 0-5.
- Weakness: Often subtle as other muscles compensate (Iliopsoas for flexion, Glutes for abduction).
Pathology: Pes Anserine Bursitis
Pathophysiology
- Inflammation: Of the bursa lying between the Pes Anserinus insertion and the MCL/Tibia.
- Causes: Overuse (Runners), Tight hamstrings, Obesity, Valgus deformity (Osteoarthritis).
- Association: Strongly associated with early OA of the medial compartment.
The term "Cyclist's Knee" generally refers to ITB, but "Breaststroker's Knee" can involve the Pes Anserinus (or MCL).
Differential Diagnosis of Medial Knee Pain
The single most examined skill here is distinguishing pes anserine pathology from the other causes of medial-sided knee pain by anatomical localisation of tenderness.
| Diagnosis | Tenderness Location | Key Discriminator | First-Line Test |
|---|---|---|---|
| Pes Anserine Bursitis | 2-3 cm distal to medial joint line, over proximal tibia | Below the joint line; negative valgus stress and McMurray | Ultrasound (fluid deep to SGT) |
| Medial Meniscus Tear | Medial joint LINE | Positive McMurray; mechanical locking/catching | MRI |
| MCL Sprain | Along the MCL (femoral/tibial attachment) | History of valgus trauma; pain on valgus stress | Clinical + stress radiograph |
| Medial Compartment OA | Diffuse medial joint line | Crepitus, age, radiographic joint-space loss | Weight-bearing radiograph |
| Tibial Subchondral Insufficiency Fracture (SIFK) | Diffuse medial, often nocturnal | Sudden severe pain in older patient; normal early radiograph | MRI (subchondral oedema) |
| Proximal Tibial Stress Fracture | Proximal medial tibia | Insidious load-related pain in runner; positive bone scan/MRI | MRI |
| Saphenous Neuralgia / Neuroma | Medial leg distal to canal | Burning/numbness, Tinel sign; prior medial surgery | Diagnostic nerve block |
Investigations
X-Ray
- AP/Lat Knee: Usually normal for bursitis. Assessing for OA (Osteophytes) or Stress Fracture (proximal tibia).
- Proximal Tibia Exostosis: Can irritate the overlying SGT tendons.
Ultrasound
- Diagnostic: Shows fluid filled bursa deep to SGT tendons.
- Guided Injection: Target for corticosteroid injection.
MRI
- Gold Standard.
- Shows local inflammation, tendonitis, or bursitis.
- Excludes meniscal tears or subchondral insufficiency fractures.
MRI is particularly useful to rule out a subtle tibial stress fracture in runners.
Management Strategy
Treatment Protocol
| Phase | Action | Goal |
|---|---|---|
| Acute | RICE, NSAIDs | Reduce inflammation |
| Subacute | Physiotherapy (Hamstring stretching) | Reduce tension |
| Persistent | Corticosteroid Injection | Therapeutic |
| Surgical | Bursectomy (Rare) | Last resort |
- Physiotherapy: Focus on correcting Valgus mechanics and stretching tight adducts/hamstrings.
- Injection: Highly effective. Must be placed into the bursa, avoiding the tendon substance.
Ultrasound guidance significantly improves the accuracy of bursal injections compared to landmark-based techniques.
Surgical Technique
Pes Anserinus Harvest (ACL)
- Incision: Vertical, medial to tibial tubercle.
- Sartorius Fascia: Incise the fascia in line with the Sartorius fibers (or L-shaped incision).
- Exposure: Reflect Sartorius fascia to reveal Gracilis and Semitendinosus deep to it.
- Preservation: Usually Sartorius is PRESERVED and repaired over the tunnels.
The Sartorius acts as the "Check Rein" or covering layer. Meticulous repair of the sartorius fascia prevents hematoma formation and assists with healing.
Complications
- Saphenous Nerve Neuralgia: Numbness or pain on medial leg/foot.
- Hematoma: Rich blood supply from segmental arteries.
- Muscle Rupture: Rare, usually at origin (ASIS avulsion in sprinters).
- Knee Instability? Sartorius plays a negligible role in stability compared to MCL/ACL.
Rehabilitation Protocol
- Bursitis: Relative rest for 2-4 weeks. Eccentric loading not typically emphasized as much as Achilles/Patella.
- Harvest: As per ACL protocol. Hamstring strength may be reduced (Sartorius contribution is minimal).
- ASIS Avulsion: Conservative management (crutches) for 4 weeks. Surgery only for large displacement (greater than 2-3cm).
Prognosis
- Bursitis: Excellent prognosis with conservative care. Check for underlying OA.
- Avulsion: Good return to sport (sprinting) after 3-4 months.
- Transfer: Sartorius transfer (for Quadriceps paralysis) has poor power generation but provides some active flexion.
Controversies & Areas of Uncertainty
Is it bursitis or tendinopathy?
The term "pes anserine bursitis" is increasingly questioned. Imaging frequently shows tendinopathy of the SGT insertion without a distended bursa, and some authors prefer "pes anserinus pain syndrome." The bursa is often anatomically inconstant.
What actually causes it?
Classic teaching links it to obesity, diabetes and medial OA. The case-control evidence (Alvarez-Nemegyei) found no association with those factors and instead implicated valgus alignment and collateral instability - a mechanical rather than metabolic model.
Steroid vs other injectates
Corticosteroid relieves symptoms short-term, but high-quality comparative data are scarce and concerns about tendon weakening persist. The roles of PRP, hyaluronic acid and ultrasound versus landmark guidance for the injection remain unresolved.
Adductor canal block extent
Debate continues over the true proximal/distal boundary of the canal, whether the block is "adductor canal" versus "subsartorial femoral triangle," and how much spread to the obturator/nerve-to-vastus-medialis contributes to analgesia and to any residual quadriceps weakness.
Evidence Base
Pes Anserinus & Anserine Bursa: Cadaveric Anatomy
Lee JH, Kim KJ, Jeong YG, et al. • Anat Cell Biol (2014)
Key Findings:
- 86 legs from 45 cadavers: Sartorius inserts into the superficial layer; Gracilis and Semitendinosus into the deep layer of the medial tibia
- Semitendinosus had a single tendon in 66%, two in 31%, three in 3% - confirming variable banding
- Anserine bursa is irregularly circular and follows the line of the Sartorius
- Recommended landmark injection: ~20 mm medial and 12 mm superior to the inferomedial point of the tibial tuberosity, 15-20 mm deep
Clinical Implication: Confirms the Sartorius is the most superficial pes component and defines a reproducible injection target for anserine bursitis.
Pes Anserinus Tendon Arrangement: Surgical Variations
Amatuzzi MM, Cocco LF, Di Dio LJA, Gotfryd AO • Ital J Anat Embryol (2002)
Key Findings:
- 60 limbs from 30 cadavers: in every specimen only THREE muscles (sartorius, gracilis, semitendinosus) formed the pes anserinus
- Despite the constant three-muscle composition, the disposition and interconnection of the tendons varied considerably
- Reinforces the S-G-T anterior-to-posterior order relevant to hamstring graft harvest
Clinical Implication: The pes is reliably a three-tendon structure, but band-level variation matters when harvesting gracilis/semitendinosus for ACL reconstruction.
Adductor Canal Block Preserves Quadriceps Strength (Volunteers)
Jaeger P, Nielsen ZJK, Henningsen MH, et al. • Anesthesiology (2013)
Key Findings:
- Randomised, double-blind, placebo-controlled crossover in healthy volunteers (11 analysed)
- Quadriceps strength fell only 8% from baseline with adductor canal block versus 49% with femoral nerve block
- Adductor canal block preserved ambulation ability better than femoral nerve block
- Confirms the canal block is predominantly a SENSORY blockade (saphenous nerve), with the Sartorius as the roof/sonic landmark
Clinical Implication: Identifying the Sartorius roof on ultrasound is the key to a motor-sparing block that facilitates early mobilisation.
Adductor Canal Block vs Femoral Nerve Block after TKA
Jaeger P, Zaric D, Fomsgaard JS, et al. • Reg Anesth Pain Med (2013)
Key Findings:
- Randomised, double-blind trial in TKA patients (48 analysed)
- Quadriceps strength was 52% of baseline with adductor canal block versus only 18% with femoral nerve block (p=0.004)
- No significant difference in morphine consumption or pain scores between groups
- Translates the volunteer findings into a clinical arthroplasty population
Clinical Implication: In TKA, the Sartorius-roofed adductor canal block protects mobilising quadriceps power without sacrificing analgesia.
Risk Factors for Pes Anserinus Tendinitis/Bursitis
Alvarez-Nemegyei J • J Clin Rheumatol (2007)
Key Findings:
- Case-control study (22 cases, 38 controls), all mature women
- Valgus knee deformity was the dominant risk factor (OR 5.2; 95% CI 1.1-25.5), rising to OR 6.0 with collateral instability
- Contrary to common teaching, NO association was found with diabetes, knee osteoarthritis or obesity in this cohort
- Suggests altered medial mechanics, not metabolic factors, drive the syndrome
Clinical Implication: Suspect pes anserine bursitis in older women with medial knee pain and valgus alignment; correct the mechanics rather than assuming a metabolic cause.
Operative Outcomes of Pelvic Apophyseal (incl. ASIS) Avulsions
Sinikumpu JJ, Hetsroni I, Schilders E, et al. • Eur J Orthop Surg Traumatol (2017)
Key Findings:
- 32 young athletes (mean 16.8 years) treated operatively for pelvic apophyseal avulsions, including ASIS (Sartorius origin)
- Over 80% returned to pre-injury sport after surgery
- Large displacement (over 20 mm) or delayed (over 3 months) surgery was NOT associated with inferior outcomes
- Most avulsions are still managed non-operatively; surgery is reserved for large/displaced fragments or failed conservative care
Clinical Implication: ASIS (Sartorius-origin) avulsions usually heal conservatively; surgery is selective and still rescues displaced cases successfully even when delayed.
Sartorius Transposition Flap for Femoral Vessel Coverage
Valenzuela CD, Finlay D, Sabry Z, et al. • Am Surg (2021)
Key Findings:
- States the sartorius muscle transposition flap is the TRADITIONAL method of covering the femoral vessels after inguinal lymphadenectomy
- Limitations of the sartorius flap: thin at its insertion, intimately related to several nerves, and contained within the field in an irradiated groin
- Describes the gracilis flap as a viable alternative when the sartorius lies within prior radiation
Clinical Implication: The Sartorius is the default flap for protecting exposed femoral vessels in the contaminated/operated groin, with gracilis reserved for the irradiated field.
Viva Scenarios
Use these scenarios to practise clinical reasoning and management decisions
CLINICAL SCENARIOStandard
Scenario 1: SGT Anatomy
CLINICAL PROMPT
"Describe the anatomy of the Pes Anserinus."
PRACTICAL APPROACH
The Pes Anserinus (Goose's Foot) is the conjoined insertion of three muscles at the proximal medial tibia. From Anterior to Posterior (and Superficial to Deep), they are: 1. Sartorius (Femoral Nerve), 2. Gracilis (Obturator Nerve), 3. Semitendinosus (Sciatic Nerve). They represent the three compartments of the thigh (Anterior, Medial, Posterior). The Pes Anserine bursa lies deep to these tendons.
KEY CLINICAL POINTS
Order: S-G-T
Nerves: Femoral, Obturator, Sciatic
Compartments: Ant, Med, Post
COMMON PITFALLS
Including Semimembranosus (it inserts deep/posteriorly)
Forgetting the bursa
FURTHER QUESTIONS
"What is the clinical significance of this area?"
"Bursitis, ACL graft harvest, and protection of the Saphenous nerve/vein."
CLINICAL SCENARIOStandard
Scenario 2: The Adductor Canal
CLINICAL PROMPT
"What forms the roof of the Adductor Canal and what structures are at risk during investigation?"
PRACTICAL APPROACH
The roof is formed by the Sartorius muscle and the subsartorial fascia. The canal contains the Femoral Artery, Femoral Vein, Saphenous Nerve, and Nerve to Vastus Medialis. The Saphenous nerve is at risk if the roof is incised carelessly or if the muscle is retracted vigorously.
KEY CLINICAL POINTS
Sartorius = Roof
Contents: FA, FV, Saphenous N, N to VM
Saphenous nerve course
COMMON PITFALLS
Listing the Profunda Femoris (it doesn't enter the canal)
Forgetting N to Vastus Medialis
FURTHER QUESTIONS
"Where does the Saphenous nerve exit?"
"It pierces the roof (fascia) between Sartorius and Gracilis distally."
CLINICAL SCENARIOStandard
Scenario 3: Medial Knee Pain
CLINICAL PROMPT
"A 60F with medial knee pain. X-ray shows mild medial OA. She has exquisite tenderness 3cm distal to the joint line. Diagnosis?"
PRACTICAL APPROACH
The specific location (distal to joint line) points to Pes Anserine Bursitis rather than just OA joint line pain. It often co-exists with OA. I would manage conservatively with NSAIDs, physiotherapy, and potentially a local steroid injection.
KEY CLINICAL POINTS
Anatomical localization (Joint line vs Pes)
Association with OA
Injection efficacy
COMMON PITFALLS
Diagnosing MCL sprain without trauma
Assuming pain is solely intra-articular
FURTHER QUESTIONS
"What is the nerve supply of the Sartorius?"
"Femoral Nerve (L2, L3)."
CLINICAL SCENARIOChallenging
Scenario 4: Hamstring Graft Harvest & Nerve Protection
CLINICAL PROMPT
"You are harvesting gracilis and semitendinosus for an ACL reconstruction. How do you find the tendons, and what nerve is at risk?"
PRACTICAL APPROACH
I make a vertical (or slightly oblique) incision over the pes anserinus, roughly 2-3 cm medial and distal to the tibial tubercle. The sartorius fascia is the first layer encountered; I incise it in line with its fibres (or as an L-shaped flap) and reflect it, which exposes gracilis (superior) and semitendinosus (inferior) on its deep surface. The sartorius itself is preserved and the fascia repaired over the tunnel. The structure most at risk is the infrapatellar branch of the saphenous nerve, which crosses the operative field transversely; it can also be threatened when passing the tendon stripper proximally where vincula tether semitendinosus to the medial gastrocnemius.
KEY CLINICAL POINTS
Sartorius fascia is the layer to incise and preserve
Gracilis is superior, semitendinosus inferior on the deep surface
Infrapatellar branch of saphenous nerve is the key structure at risk
Watch the tendon-stripper path (semitendinosus accessory bands to gastrocnemius)
COMMON PITFALLS
Transecting the sartorius rather than reflecting its fascia
Forgetting the infrapatellar branch and causing anterior knee numbness
Amputating the graft short by catching an accessory band with the stripper
FURTHER QUESTIONS
"Why preserve and repair the sartorius fascia?"
"It restores the gliding layer, reduces haematoma, and helps anchor the residual tendon stumps."
CLINICAL SCENARIOChallenging
Scenario 5: Meralgia Paraesthetica after Anterior Hip Surgery
CLINICAL PROMPT
"A patient develops burning numbness over the lateral thigh after an anterior approach to the hip. Which nerve, and how does it relate to the Sartorius?"
PRACTICAL APPROACH
This is meralgia paraesthetica from injury to the lateral cutaneous (femoral cutaneous) nerve of the thigh. The nerve typically passes under or through the inguinal ligament just medial to the ASIS and runs close to - sometimes through - the proximal origin of Sartorius. The anterior (Smith-Petersen / direct anterior) approach and ASIS bone-graft harvest both place it at risk. Management is initially expectant, as many neurapraxic injuries recover; persistent symptoms may need desensitisation, neuropathic agents, or rarely neurolysis/excision.
KEY CLINICAL POINTS
Lateral cutaneous nerve of thigh (L2-L3)
Runs near the ASIS, related to the Sartorius origin
Classic in direct anterior hip approach and ASIS graft harvest
Purely sensory - lateral thigh numbness/burning, no motor loss
COMMON PITFALLS
Confusing it with a femoral nerve injury (that would cause quadriceps weakness)
Rushing to surgery before allowing neurapraxia to recover
FURTHER QUESTIONS
"How can the risk be reduced intra-operatively?"
"Keep dissection lateral at the ASIS, protect the interval, and avoid aggressive medial retraction near the nerve."
MCQ Practice Points
Nerve Supply
Q: The Sartorius muscle is innervated by which nerve? A: Femoral Nerve.
Pes Anserinus
Q: Which muscle forms the most anterior part of the Pes Anserinus? A: Sartorius. (SGT order).
Adductor Canal
Q: Which structure forms the roof of the Adductor Canal? A: Sartorius.
Action
Q: Which muscle acts to flex, abduct, and externally rotate the hip? A: Sartorius.
Origin
Q: An avulsion fracture of the ASIS involves the origin of which muscle? A: Sartorius. (Rectus Femoris is AIIS).
Guidelines, Registries & Global Practice
Global Epidemiology
- Pes anserine pain syndrome is a common cause of medial knee pain in middle-aged and older adults, with a clear female predominance; community surveys (Mexican COPCORD data) place anserine bursitis among the more frequent regional rheumatic pain syndromes (~0.34% prevalence).
- ASIS apophyseal avulsions cluster in adolescent athletes (mean age ~14-15 years), the ASIS accounting for roughly a third of pelvic apophyseal avulsions, the anterior inferior iliac spine being the commonest.
Side-by-Side Guidance (where recommendations differ)
| Theme | Position | Source / Society |
|---|---|---|
| ACL graft choice | Hamstring (gracilis/semitendinosus) and BPTB both endorsed; surgeon/patient-specific selection | AAOS ACL Clinical Practice Guideline (US) |
| ACL graft choice | Registry data inform graft and fixation choice and revision risk | NLR (Norwegian) & Swedish/Danish ACL registries |
| TKA analgesia | Multimodal, opioid-sparing regional analgesia; motor-sparing blocks favoured to enable rapid recovery | PROSPECT / ERAS arthroplasty consensus |
| Adductor canal block | Preferred over femoral nerve block for quadriceps-sparing analgesia after TKA | Level 1 RCT evidence (Jaeger 2013) |
| Pelvic avulsion fracture | Non-operative for minimally displaced; ORIF for large/displaced fragments or failed conservative care | International case-series consensus |
Registry Notes
- Although the Sartorius itself is not implanted, national ACL registries (Scandinavian, UK, and others) track the hamstring grafts harvested through the sartorius layer, informing graft survival, re-rupture and revision rates that guide graft selection globally.
High- vs Limited-Resource Practice Variation
- Adductor canal block depends on ultrasound availability; in high-resource settings it is routine for TKA, whereas landmark-based femoral nerve blocks or systemic analgesia may dominate where ultrasound is scarce.
- Pes anserine bursitis is largely a clinical diagnosis worldwide; MRI/ultrasound confirmation is reserved for atypical cases or where stress fracture/SIFK must be excluded - imaging access varies markedly by setting.
- ASIS avulsion is managed conservatively in the great majority of cases everywhere, which keeps treatment robust to resource constraints; operative fixation is selective.
Clinical summary
Anatomy
- •Origin: ASIS
- •Insert: Pes Anserinus
- •Nerve: Femoral (L2/3)
- •Longest muscle
Relationships
- •Roof of Hunter's Canal
- •Lat border Femoral Triangle
- •Saphenous N runs deep
- •SGT: Sartorius, Gracilis, SemiT
Clinical
- •Action: FABER
- •Pathology: Pes Bursitis
- •Hazard: ASIS Avulsion
- •Block: Adductor Canal