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The Nerves of the Adductor Canal and the Innervation of the Knee: An Anatomic Study

Burckett-St. Laurant, David MBBS, FRCA; Peng, Philip MBBS, FRCPC; Girón Arango, Laura MD; Niazi, Ahtsham U. MBBS, FCARCSI, FRCPC; Chan, Vincent W.S. MD, FRCPC, FRCA; Agur, Anne BScOT, MSc, PhD; Perlas, Anahi MD, FRCPC

Regional Anesthesia and Pain Medicine: May/June 2016 - Volume 41 - Issue 3 - p 321–327
doi: 10.1097/AAP.0000000000000389

Background and Objectives Adductor canal block contributes to analgesia after total knee arthroplasty. However, controversy exists regarding the target nerves and the ideal site of local anesthetic administration. The aim of this cadaveric study was to identify the trajectory of all nerves that course in the adductor canal from their origin to their termination and describe their relative contributions to the innervation of the knee joint.

Methods After research ethics board approval, 20 cadaveric lower limbs were examined using standard dissection technique. Branches of both the femoral and obturator nerves were explored along the adductor canal and all branches followed to their termination.

Results Both the saphenous nerve (SN) and the nerve to vastus medialis (NVM) were consistently identified, whereas branches of the anterior obturator nerve were inconsistently present. The NVM contributed significantly to the innervation of the knee capsule, through intramuscular, extramuscular, and deep genicular nerves. The SN had a relatively more modest contribution through superficial infrapatellar and posterior branches as well as contributing to the origin of the deep genicular nerves.

Conclusions The results suggest that both the SN and NVM contribute to the innervation of the anteromedial knee joint and are therefore important targets of adductor canal block. Given the site of exit of both nerves in the distal third of the adductor canal, the midportion of the adductor canal is suggested as an optimal site of local anesthetic administration to block both target nerves while minimizing the possibility of proximal spread to the femoral triangle.

From the *Department of Anaesthesia, University Hospital of Wales, Cardiff, United Kingdom; †Department of Anesthesia, University of Toronto; ‡Department of Anesthesia, University Health Network, Toronto, Ontario, Canada; §Department of Anesthesia, Universidad CES, Medellin, Colombia; and ∥Department of Anatomy, University of Toronto, Toronto, Ontario, Canada.

Accepted for publication January 14, 2016.

Address correspondence to: Anahi Perlas, MD, FRCPC, Department of Anesthesia, University Health Network, 399 Bathurst St, Toronto, Ontario, Canada M5T 2S8 (e-mail:

Dr Philip Peng receives ultrasound equipment support from SonoSite Fujifilm Canada. Dr Vincent W.S. Chan receives ultrasound equipment support for research from BK Medical and consultation fees from Philips Medical Systems and Smiths Medical. The other authors declare no conflict of interest.

Dr Ahtsham U. Niazi received support for academic time from the Department of Anesthesia, University of Toronto through Merit Award competitions.

Copyright © 2016 by American Society of Regional Anesthesia and Pain Medicine.