sábado, 1 de agosto de 2015

Innervation of the Anterior Capsule of the Human Knee: Implications for Radiofrequency Ablation.


-Background and Objectives: Chronic knee pain is common in all age groups. Some patients who fail conservative theraphy benefit from radiofrequency neurotomy, Knowledge of the anatomy is critical to ensure a successfull outcome. The purpose of this study was to reanalyze the innervation to the anterior knee capsule from the perspective of the interventional pain practitioner.

-Methods: The study included a comprehensive literature review followed by dissection of 8 human knees to identify the primary capsular innervation of the anterior knee joint. Photographs and measurements were obtained for each relevant nerve branch. Stainless-steek wures were placed along the course of each primary innervation, and radiographs were obtained.

-Results; Literature review revealed a lack of consensus on the number and origin of the nerve branches innervating the anterior knee capsule. All dissections revealed the following 6 nerves: superolateral branch from the vastus lateralis, superomedial branch from the vastus medialis, middle branch from the vastus intermedius, inferolateral (recurrent) branch from the common peroneal nerve, inferomedial branch from the saphenous nerve, and lateral articular nerve branch from the common peroneal nerve.

Nerve branchess showed variable proximal trajectories but constant distal points of the contact with femur and tibia. The inferolateral peroneal nerve branch was found to be too close to the common peroneal nerve, making it inappropiate for radiofrequency neurotomy.

-Conclusions; The innervation of the anterior capsule of the knee joint seems to follow a constant pattern making at least 3 of these nerves accessible to percutaneous ablation. To optimize clinical outcome, well-aligned radiographs are critical to guide lesion placement.

Authors: Franco CD, Buvanendran A, Petersohn JD, Menzies RD, Menzies LP.

Citation: Reg Anesth Pain Med. 2015 Jul-Aug; 40(4):363-8 doi: 10.1097/AAP.0000000000000269.

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