An incision is made starting as far proximally as possible and directly over the adductor longus tendon. The incision is carried through the subcutaneous tissue. The adductor longus tendon is easily palpated. In adults, these tendons are much, much bigger than what you would expect based on any experience you may have in pediatric orthopaedics. The adductor longus fascia is split. Just posterior to it is the long, flat origin of the gracilis muscle, which is very thin but very wide, from 6 to 7 cm in an anterior to posterior direction. Just lateral to the adductor longus is the adductor brevis. Again, this muscle is much bigger than generally appreciated and it is usually difficult to pass a large hemostat entirely around the muscle. When the muscle is released, it is usually released in stages. If the approach is being carried over to the iliacus and psoas tendons, then the pectineus with the femoral neurovascular bundle is retracted anteriorly and the femur is palpated. In children, this retraction allows the hip capsule to be exposed.
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