Distribution of sensory nerves supplying the knee joint capsule and implications for genicular blockade and radiofrequency ablation: an anatomical study.
Aged
Aged, 80 and over
Anatomic Landmarks
Arthralgia
/ therapy
Cadaver
Catheter Ablation
/ methods
Dissection
Female
Humans
Joint Capsule
/ diagnostic imaging
Knee Joint
/ diagnostic imaging
Male
Nerve Block
/ methods
Obturator Nerve
/ anatomy & histology
Peroneal Nerve
/ anatomy & histology
Quadriceps Muscle
/ innervation
Radiography
Sciatic Nerve
/ anatomy & histology
Ultrasonography, Interventional
Anatomical landmarks
Genicular blockade
Genicular nerve
Knee innervation
Radiofrequency ablation
Journal
Surgical and radiologic anatomy : SRA
ISSN: 1279-8517
Titre abrégé: Surg Radiol Anat
Pays: Germany
ID NLM: 8608029
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
received:
08
11
2018
accepted:
15
07
2019
pubmed:
25
7
2019
medline:
28
4
2020
entrez:
25
7
2019
Statut:
ppublish
Résumé
Despite their emerging therapeutic relevance, there are many discrepancies in anatomical description and terminology of the articular nerves supplying the human knee capsule. This cadaveric study aimed to determine their origin, trajectory, relationship and landmarks for therapeutic purpose. We dissected 21 lower limbs from 21 cadavers, to investigate the anatomical distribution of all the articular nerves supplying the knee joint capsule. We identified constant genicular nerves according to their anatomical landmarks at their entering point to knee capsule and inserted Kirschner wires through the nerves in underlying bone at those target points. Measurements were taken, and both antero-posterior and lateral radiographs were obtained. The nerve to vastus medialis, saphenous nerve, anterior branch of obturator nerve and a branch from sciatic nerve provide substantial innervation to the medial knee capsule and retinaculum. The sciatic nerve and the nerve to the vastus lateralis supply sensory innervation to the supero-lateral aspect of the knee joint while the fibular nerve supplies its infero-lateral quadrant. Tibial nerve and posterior branch of obturator nerve supply posterior aspect of knee capsule. According to our findings, five constant genicular nerves with accurate landmarks could be targeted for therapeutic purpose. The pattern of distribution of sensitive nerves supplying the knee joint capsule allows accurate and safe targeting of five constant genicular nerves for therapeutic purpose. This study provides robust anatomical foundations for genicular nerve blockade and radiofrequency ablation.
Sections du résumé
BACKGROUND
BACKGROUND
Despite their emerging therapeutic relevance, there are many discrepancies in anatomical description and terminology of the articular nerves supplying the human knee capsule. This cadaveric study aimed to determine their origin, trajectory, relationship and landmarks for therapeutic purpose.
METHODS
METHODS
We dissected 21 lower limbs from 21 cadavers, to investigate the anatomical distribution of all the articular nerves supplying the knee joint capsule. We identified constant genicular nerves according to their anatomical landmarks at their entering point to knee capsule and inserted Kirschner wires through the nerves in underlying bone at those target points. Measurements were taken, and both antero-posterior and lateral radiographs were obtained.
RESULTS
RESULTS
The nerve to vastus medialis, saphenous nerve, anterior branch of obturator nerve and a branch from sciatic nerve provide substantial innervation to the medial knee capsule and retinaculum. The sciatic nerve and the nerve to the vastus lateralis supply sensory innervation to the supero-lateral aspect of the knee joint while the fibular nerve supplies its infero-lateral quadrant. Tibial nerve and posterior branch of obturator nerve supply posterior aspect of knee capsule. According to our findings, five constant genicular nerves with accurate landmarks could be targeted for therapeutic purpose.
CONCLUSION
CONCLUSIONS
The pattern of distribution of sensitive nerves supplying the knee joint capsule allows accurate and safe targeting of five constant genicular nerves for therapeutic purpose. This study provides robust anatomical foundations for genicular nerve blockade and radiofrequency ablation.
Identifiants
pubmed: 31338537
doi: 10.1007/s00276-019-02291-y
pii: 10.1007/s00276-019-02291-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1461-1471Références
Osteoarthritis Cartilage. 2017 Aug;25(8):1247-1256
pubmed: 28336454
Surg Radiol Anat. 2017 Oct;39(10):1085-1095
pubmed: 28357555
Pain. 2011 Mar;152(3):481-7
pubmed: 21055873
Pain Physician. 2015 Sep-Oct;18(5):E899-904
pubmed: 26431143
Clin Orthop Relat Res. 1994 Apr;(301):221-6
pubmed: 8156678
Reg Anesth Pain Med. 2017 Jan/Feb;42(1):90-98
pubmed: 27922951
Reg Anesth Pain Med. 2015 Jul-Aug;40(4):363-8
pubmed: 26066383
Ir J Med Sci. 2015 Mar;184(1):201-6
pubmed: 24535194
Pain Physician. 2014 May-Jun;17(3):E339-48
pubmed: 24850115
Pain Med. 2017 Sep 1;18(9):1631-1641
pubmed: 28431129
J Exp Orthop. 2015 Dec;2(1):16
pubmed: 26914884
Reg Anesth Pain Med. 2016 Nov/Dec;41(6):711-719
pubmed: 27685346
Anat Rec. 1948 May;101(1):109-30
pubmed: 18915634
Anesth Analg. 2004 Jul;99(1):251-4
pubmed: 15281539
PM R. 2017 Feb;9(2):149-153
pubmed: 27346091
Surg Radiol Anat. 2017 Jun;39(6):611-618
pubmed: 27878340
J Knee Surg. 2017 Jul;30(6):585-593
pubmed: 27846646
Int Orthop. 2000;24(1):1-4
pubmed: 10774852
Am J Sports Med. 1982 Nov-Dec;10(6):329-35
pubmed: 6897495
J Pain Res. 2018 Sep 18;11:1879-1888
pubmed: 30271194
Reg Anesth Pain Med. 2016 May-Jun;41(3):321-7
pubmed: 27015545
Clin Orthop Relat Res. 2009 Sep;467(9):2208-14
pubmed: 19529972
Reg Anesth Pain Med. 2018 May;43(4):407-414
pubmed: 29557887
Pain Pract. 2017 Jun;17(5):578-588
pubmed: 27641918