Cadaveric study of the infrapatellar branch of the saphenous nerve: Can damage be prevented in total knee arthroplasty?

Abstract

Background: The infrapatellar branch of the saphenous nerve (IPBSN) is a purely sensory nerve innervating the anteromedial aspect of the knee and anteroinferior knee joint capsule. Total knee arthroplasty (TKA) is commonly used to treat end-stage arthritis, but the IPBSN is often injured and results in numbness around the anteromedial knee. The aim of this cadaveric study was to describe the course and variability of the IPBSN and to assess whether it is possible to preserve during a standard midline surgical approach in TKA. Methods: Ten fresh-frozen cadaver legs were dissected using a midline approach to the knee. Skin and subcutaneous flap were reflected to expose both the saphenous nerve and its branches. The branches of the IPBSN were identified, and their vertical distances above the tibial tuberosity (TB) were recorded: TB to inferior branch, to middle branch, and to superior branch. Results: There were 10 left-sided specimens (6 female, 4 male) with a mean age of 79.9 AE 9.8 years. 8 (80%) specimens had 2 branches of IPBSN while 2 (20%) specimens had 3 branches. The average distance from TB to the inferior branch was 16.8 AE 8.3 mm (3.0-28.0); middle branch, 24.0 AE 1.4 mm (23.0-24.9); and superior, 45.9 AE 7.7 mm (32.0-54.5). Conclusion: Our cadaveric study found no consistent way to preserve the IPBSN using a standard midline approach in TKA. It is important to provide proper patient education on this complication, and surgeons should be aware of approximate locations and variations of IPBSN while performing other knee procedures.

The Effect of Sensory Deficit After Total Knee Arthroplasty on Patient Satisfaction and Kneeling Ability

“…This finding is supported by Lee et al. [ 4 ]. In this cadaveric study, infrapatellar branches of saphenous nerve were identified proximally to the tibial tubercle leading the authors to conclude that that there was no consistent way to preserve lateral skin innervation using a traditional midline approach.…”

“…Numbness surrounding the incision after total knee arthroplasty is a frequently reported outcome with rates ranging from 27% to 100% [ [1] , [2] , [3] ]. Denervation is caused by damage to the medial femoral cutaneous nerve and infrapatellar branch of the saphenous nerve which course from medial to lateral and provide sensation to the lateral skin [ 4 ]. Both nerves are disrupted during routine total knee arthroplasty by traditional midline incisions [ 4 ].…”

“…Denervation is caused by damage to the medial femoral cutaneous nerve and infrapatellar branch of the saphenous nerve which course from medial to lateral and provide sensation to the lateral skin [ 4 ]. Both nerves are disrupted during routine total knee arthroplasty by traditional midline incisions [ 4 ]. There is conflicting evidence about the significance of postoperative skin numbness, and the overall effect on patient outcomes is largely unknown.…”

Neuroma of the Infrapatellar branch of the saphenous nerve following Total knee Arthroplasty: a case report

“…However a study performed by Kerver et al found that the location of the IBSN is highly variable, and a safe zone is therefore difficult to define before incision [22]. A recent cadaveric study by Lee et al claimed that there was no consistent way to preserve the IBSN using a standard midline approach in TKA and patient education on this complication is therefore important [23].…”

The Eeklo Modified Subvastus Approach for Total Knee Arthroplasty: Detailed Surgical Tips and Tricks

“…The MPFQ-complex is a crucial soft tissue element that needs to be repaired. It contains in addition a medial patellotibial ligament and a medial patellomeniscal ligament [9][10][11][12].…”