An anatomical neurovascular study for procedures targeting peri-articular nerves in patients with anterior knee pain

Abstract

Background: Radiofrequency ablation (RFA) of the articular branches innervating the anterior knee capsule has been studied as a possible alternative to surgery for degenerative arthritis. However, the neurovascular topography of the anterior knee capsule remains unclear. Methods: One leg from each of the 20 formalin-embalmed cadaveric specimens was investigated. Modified ablation points (MAPs) were evaluated for a possible alternative for conventional target points (CAPs). Results: For the nerve to vastus medialis (NVM), the probability of identifying the nerve was higher at MAP compared with CAP (62.5% vs. 25%). The mean shortest distance from the nerve was shorter at MAP compared with CAP (18.0 mm vs. 29.9 mm). The probabilities and distances for other nerves were not significantly different between the points. However, the probability of identifying the artery was significantly lower at MAPs compared with CAPs for arteries (0%, 5.3%, and 0% vs. 84.2%, 84.2%, and 73.3% for superior medial genicular, superior lateral genicular, and inferior medial genicular artery, respectively). For the recurrent peroneal nerve (RPN), a new target point was set in MAPs. Conclusions: The current landmark for genicular nerve procedures may not accurately target the correct nerve position, or reduce the risk for vessel damage. A more proximal target may reduce complications and increase the probability of successful procedures, although clinical correlation is needed.

Investigation of the existence of and a block technique for the inferior lateral genicular nerve: cadaveric study

“…One exception was the ‘lateral retinacular nerve’ described in a single cadaveric study [ 25 ], but the authors could not find other studies regarding this structure arising from the CPN. Additionally, two other anatomical studies defined this structure as originating from the sciatic nerve or its branches [ 8 , 21 ].…”

“…Innervation of the knee joint is complicated yet has been a topic of interest to clinicians for decades [ 5 – 8 ], as precise identification of the peripheral nerves of the knee joint could be utilized for the nerve block itself and other pain interventions. The indications of periarticular nerve block have been widely applied in various settings, including in perioperative analgesia, chronic pain control, and emergency medicine [ 9 – 12 ].…”

A Randomized Controlled Pilot Study Using Ultrasound-Guided Percutaneous Cryoneurolysis of the Infrapatellar Branch of the Saphenous Nerve for Analgesia Following Total Knee Arthroplasty

“…And while a recent randomized placebo-controlled trial comparing a “blind” landmark-based cryoneurolysis technique for TKA was negative for its primary end point, secondary outcomes suggested a similar reduction in opioid consumption through 6 weeks [ 12 ]. Unfortunately, landmark-based targeting of the genicular nerves may not reliably block the individual nerves given anatomic variations, and ultrasound visualization of small genicular nerves can be challenging [ 13 ]. Thus, prospective studies investigating ultrasound-guided targeting of these nerves for cryoneurolysis are warranted.…”

Adductor canal block versus intra-articular steroid and lidocaine injection for knee osteoarthritis: a randomized controlled study

“…Park et al [ 35 ] suggested that antero-medial knee innervation is from the nerve to the vastus medialis and the infrapatellar branch of the saphenous nerve that divides into multiple smaller branches distally, making sonographic identification challenging. They concluded that more proximal targets reduce complications as well as increased probability of successful analgesia.…”