Incidence of Encountering the Infrapatellar Nerve Branch of the Saphenous Nerve During a Midline Approach for Total Knee Arthroplasty

James, Nicholas F.; Kumar, Arun; Wilke, Benjamin K; Shi, Glenn G.

doi:10.5435/jaaosglobal-d-19-00160

Cited by 7 publications

(9 citation statements)

References 25 publications

(43 reference statements)

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“…The infrapatellar branch of the saphenous nerve provides sensory innervation to the anterior knee (James et al, 2019). The variations of this branch warrant attention since it is liable to get injured in surgical procedures involving the knee due to its proximity to the PL.…”

Section: Discussionmentioning

confidence: 99%

The patellar ligament: A comprehensive review

2021

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The patellar ligament (PL) is an epiphyseal ligament and is part of the extensor complex of the knee. The ligament has gained attention due to its clinical relevance to autograft and tendinopathy. A variety of anatomical variations of the PL such as aplasia, numerical variations, and vascularity are being reported recently by clinicians and anatomists. The aim of this literature was to review the available literature to provide a consensus regarding anatomic variations of the PL, neurovasculature surrounding the PL, histology of the PL, and various aspects of PL measurements with relevance to the surgical considerations and sex and age-related differences. A narrative review of the patellar ligament was performed by conducting a detailed literature search and review of relevant articles. A total of 90 articles on the patellar ligament were included and were categorized into studies based on anatomical variations, neurovasculature, morphometrics, microanatomy, sex and age-related difference, and ACL reconstruction. The anatomical variations and morphometrics of the PL were found to correlate with the frequency of strain injuries, tendinopathy, and efficacy of the PL autograft in anterior cruciate ligament reconstruction. The sex differences in PL measurements and the effect of estrogen on collagen synthesis explained a higher incidence of patellar tendinopathy in women. An awareness of its variations enables careful selection of surgical incisions, thereby avoiding complications related to nerve injury. Accurate knowledge of the PL microanatomy assists in understanding the mechanism of ligament degeneration, rupture, autograft harvesting, and ligamentization results.

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Section: Discussionmentioning

confidence: 99%

The patellar ligament: A comprehensive review

2021

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“…The common applied medial parapatellar approach in TKA may increase the likelihood of the development of ISN[ 9 ]. James et al [ 2 ] performed a clinical study in primary TKA patients to identify the location of the IPSN and determine whether it could be transected during a standard medial arthrotomy. They found that the nerve was, on average, between 2.58 and 3.06 cm below the inferior pole of the patella.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative pain after total knee arthroplasty (TKA) is a complex and multifactorial issue. Infection, loosening, instability, component malalignment, poor ligament balance, and complex regional pain syndrome may lead to knee pain, stiffness, and poor functional outcome[ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment outcome of painful traumatic neuroma of the infrapatellar branch of the saphenous nerve during total knee arthroplasty

Chalidis¹,

Kitridis²,

Givissis³

2021

WJO

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BACKGROUND Development of infrapatellar saphenous neuroma (ISN) is a well-recognized reason for knee pain following total knee arthroplasty (TKA). So far, very few studies have addressed the development of painful ISN after TKA and its impact on functional outcome and patient satisfaction. AIM To present the results of surgical treatment for ISN after primary TKA, the level of pain relief, and the improvement of knee motion and function. METHODS Fifteen patients (13 women, 2 men) with persistent medial pain for more than six months after primary TKA, due to osteoarthritis, underwent surgical excision of ISN. ISN diagnosis was confirmed with the presence of Tinel’s sign along the course of the infrapatellar branch of the saphenous nerve and with pain relief after selective nerve block using local anesthetic. Component loosening, malalignment, instability and infection were excluded systematically in all patients as a source of pain. Pain relief in terms of visual analog scale (VAS), active knee range of motion (ROM), and the Knee Society Score (KSS) for pain and function were evaluated preoperatively and at least six months postoperatively. RESULTS The mean patients’ age was 71.3 ± 5.4 years old. The mean interval between TKA and neuroma excision was 10 mo (range, 6 to 14 mo), while the mean follow-up was 8 mo (range: 6 to 11 mo). All 15 patients experienced almost complete immediate pain relief and resolution of allodynia and hyperesthesia after surgery. Pain on the VAS scale improved from 8.6 ± 1.3 preoperatively to 0.8 ± 0.9 at the final follow-up ( P = 0.001). KSS pain and function scores were improved from 49.3 ± 5.9 and 62.7 ± 12.8 before surgery to 91.8 ± 4.2 and 75.3 ± 11.3 after surgery, respectively ( P = 0.001 and P = 0.015). Active knee ROM was also increased postoperatively from 96 ± 4 to 105 ± 6 degrees ( P = 0.001). There were no complications and no further operations required. CONCLUSION ISN should be considered a potential cause of persistent pain following TKA. Neuroma excision not only provides immediate pain relief and resolution of symptoms but may also improve the knee range of motion.

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“…Iatrogenic injury of the IPBSN has been described within orthopaedic literature during several knee surgical procedures, including TKA. The nerve was encountered in all knees with a mean distance of 2.82 cm distal to the inferior pole of the patella during primary TKA in a study by James et al [ 4 ]. The incidence of IPBSN injury during TKA ranges from 85% to 100% according to various studies [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The standard surgical approach for TKA is a midline skin incision with medial parapatellar arthrotomy [ 2 ]. During this approach, the infrapatellar branch of the saphenous nerve (IPBSN) is transected, resulting in an area of altered sensation lateral to the incision, ranging from mild paresthesia to complete anesthesia [ [3] , [4] , [5] , [6] , [7] , [8] ]. In few cases, a cutaneous lesion may occur in this area of altered sensation [ [9] , [10] , [11] , [12] , [13] , [14] ].…”

Section: Introductionmentioning

confidence: 99%

SKINTED: A Rare Complication After Total Knee Arthroplasty

et al. 2020

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Background: Surgery of the knee, injury to the infrapatellar branch of the saphenous nerve, traumatic eczematous dermatitis is a neuropathic dermatitis specific to total knee arthroplasty (TKA), occurring around the healed surgical scar area. Very few case reports exist in orthopaedic literature regarding this rare skin complication after TKA. We report a series of cases and estimated the incidence of this condition in our institute. Methods: During the 1-year period from January 2018 to December 2018, patients who have undergone TKA and later presented with skin lesions adjacent to the operated site were identified. Detailed history was taken, and full clinical examination was performed for all the reported cases. Results: A total of 9 lesions in 8 patients were identified out of a total of 203 consecutive TKAs operated during the study period, with an estimated incidence of 4.4%. The mean age was 64 years (range, 58-78 years). The mean time from surgery to diagnosis was 4 months (range, 3-6 months). Conclusions: This group of dermatitis caused due to surgical transection of the infrapatellar branch of the saphenous nerve during TKA is a rare cutaneous complication, with an estimated incidence of 4.4% from this study. Lesions typically appear lateral to the operative scar within an area of hypoesthesia. Lesions in all patients improved after topical steroid therapy with no recurrences at further follow-up. Arthroplasty surgeons should have awareness of this benign complication, thereby avoiding unwarranted additional workup and alleviating unnecessary psychological stress to the patient.

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Incidence of Encountering the Infrapatellar Nerve Branch of the Saphenous Nerve During a Midline Approach for Total Knee Arthroplasty

Cited by 7 publications

References 25 publications

The patellar ligament: A comprehensive review

The patellar ligament: A comprehensive review

Surgical treatment outcome of painful traumatic neuroma of the infrapatellar branch of the saphenous nerve during total knee arthroplasty

SKINTED: A Rare Complication After Total Knee Arthroplasty

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