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Body Surface

The primary surface landmarks of the anterior and medial thigh are associated with the inominate (anterior superior iliac spine, pubic crest and tubercle, and inguinal ligament), femur (medial condyle and epicondyle), patella and tibia (tibial tuberosity and patellar ligament). The skin overlying the anterior and medial thigh is innervated by the subcostal, lateral cutaneous of thigh, femoral branch of genitofemoral, medial and intermediate (femoral) cutaneous, obturator, saphenous, and lateral cutaneous of calf nerves.

Skeleton and Joints

The bones and joints associated with the anterior and medial thigh are the inominate and femur articulating at the hip joint, and the femur, patella and tibia articulating at the knee joint. The hip joint moves in flexion and extension, abduction and adduction, medial and lateral rotation, and circumduction (combining elements of the other movements). The knee joint moves in flexion and extension, and slight medial and lateral rotation (locking and unlocking knee with flexion and extension).

Fascial Organization

The fascia lata (deep fascia of the thigh) extends from the sacrum and inominate (iliac crest, inguinal ligament, inferior pubic ramus, ischial ramus and tuberosity, and sacrospinous ligament) to the knee. It is thickened laterally as the iliotibial tract and has three intermuscular septa attaching to the linea aspera of the femur. The septa divide the thigh into three ( anterior/extensor, posterior/flexor and medial/adductor) compartments. The lateral septum separates the anterior and posterior compartments. The medial septum separates the anterior and medial compartments and a third intermuscular septum separates the medial and posterior compartments.

Muscles

The anterior compartment muscles are primarily active in flexion ( sartoriusand rectus femoris) of the hip and extension (rectus femoris, vastus lateralis, vastus intermedius and vastus medialis) of the knee. Although not included as muscles of the anterior compartment of the thigh, the tensor fasciae latae, iliopsoas and pectineus muscles are active in flexion of the hip. The medial compartment muscles are primarily active in adduction ( adductor brevis, adduction longus, adductor magnus and gracilis) of the hip with minor contributions to flexion (adductor longus), extension (adductor magnus) and lateral rotation ( obturator externus) of the hip.

Innervation

The muscles of the anterior compartment are innervated by branches of the femoral nerve, whereas the muscles of the medial compartment are innevated by branches of the obturator nerve (the hamstring portion of the adductor magnus is innervated by the tibial division of the sciatic nerve).

Blood Supply

The anterior compartment is primarily supplied by the femoral, lateral circumflex femoral and medial circumflex femoral arteries. The medial compartment is primarily supplied by the obturator, medial femoral circumflex and profunda femoral arteries.

Anatomical Spaces or Features

The saphenous opening is a defect in the fascia lata positioned inferior to the ingulinal ligament through which the great saphenous and other superficial veins drain into the femoral vein. The saphenous opening is superficial to the femoral triangle. The femoral triangle is bounded by the inguinal ligament (base), sartorius muscle (lateral) and adductor longus muscle (medial). The iliopsoas and pectineus muscles form its floor and the triangle contains the femoral vein, artery and nerve, and lymphatic vessels and nodes. The femoral sheath is a funnel-like extension of the iliacus (posterior) and transversalis fasciae (anterior) within the femoral triangle. The femoral sheath is subdivided into three compartments containing the femoral artery (lateral), femoral vein (intermediate) and lymphatics (medial). Its proximal end, the femoral opening, is positioned posterior to the inguinal ligament and is continuous with the pelvic cavity. The adductor canal is a fascial / apponeurotic tube extending from the apex of the femoral triangle to the adductor hiatus. The adductor canal contains the femoral artery and vein, both of which traverse the adductor hiatus (a defect in the adductor magnus) to reach the popliteal fossa.