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Anatomical Study of the Innervation of Anterior Knee Joint Capsule: Implication for Image-Guided Intervention

Tran, John, HBSc*; Peng, Philip, W.H., MBBS; Lam, Karen, MD; Baig, Ehtesham, MD; Agur, Anne, M.R., PhD*; Gofeld, Michael, MD

Regional Anesthesia and Pain Medicine: May 2018 - Volume 43 - Issue 4 - p 407–414
doi: 10.1097/AAP.0000000000000778
Chronic and Interventional Pain: Original Articles

Background and Objectives The knee joint is the most common site of osteoarthritis. While joint replacement is considered an ultimate solution, radiofrequency denervation may be contemplated in some cases. Radiofrequency ablation requires precise localization of the articular branches innervating the joint capsule. The objective of this cadaveric study was to determine the source, course, relationships, and frequency of articular branches innervating the anterior knee joint capsule.

Methods Fifteen knees were meticulously dissected. The number and origin of the articular branches were recorded, and their distribution defined by quadrants. Their relationships to anatomical landmarks were identified.

Results The articular branches terminated in 1 of the 4 quadrants with minimal overlap. In all specimens, the superolateral quadrant was innervated by the nerve to vastus lateralis, nerve to vastus intermedius, superior lateral genicular and common fibular nerves; inferolateral by the inferior lateral genicular and recurrent fibular nerves; superomedial by the nerve to vastus medialis, nerve to vastus intermedius and superior medial genicular nerve; and inferomedial by the inferior medial genicular nerve. In 3 specimens, the inferomedial quadrant also received innervation from the infrapatellar branch of saphenous nerve. All articular branches except the nerves to vastus lateralis and medialis course at the periosteal level.

Conclusions The frequency map of the articular branches provides an anatomical basis for the development of new clinical protocols for knee radiofrequency denervation and perioperative pain management.

From the *Division of Anatomy, Department of Surgery, and †Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.

Accepted for publication January 15, 2018.

Address correspondence to: Philip W.H. Peng, MBBS, Department of Anesthesia, University of Toronto, 399 Bathurst St, McL 2-405 Toronto, Ontario, Canada M5T 2S8 (e-mail: philip.peng@uhn.ca).

The authors declare no conflict of interest.

Funding was provided through Merit Award in Research, Department of Anesthesia, University of Toronto (to P.W.H.P.) and Physicians' Service Incorporated Foundation award (to P.W.H.P. and K.L.).

Interim data from this work were presented at the 2017 Annual Meeting of American Association of Clinical Anatomists in Minneapolis, MN, on July 17 to 21, 2017; at the 2017 World Academy of Pain Medicine Ultrasonography Annual Meeting and Workshop in Miami, FL, on January 13 to 15, 2017; and at the 2017 Study in Multidisciplinary Pain Research—International Symposium of Ultrasound in Regional Anesthesia Congress in Florence, Italy, on March 29 to April 1, 2017.

Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.