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Distribution of sensory nerves supplying the knee joint capsule and implications for genicular blockade and radiofrequency ablation: an anatomical study

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Abstract

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

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

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

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.

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Acknowledgements

The authors thank the donors of the cadavers used in this study and their families.

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Authors and Affiliations

  1. Neuro-Musculo-Skeletal Pole (NMSK), Experimental and Clinical Research Institute (IREC), Université Catholique de Louvain (UCLouvain), Tour Pasteur, Avenue Mounier 53, 1200, Brussels, Belgium

    Loïc Fonkoué, Jean-Éric K. Kouassi, Christine Detrembleur, Emmanuel Thienpont & Olivier Cornu

  2. Pole of Morphology, Université Catholique de Louvain (UCLouvain), Brussels, Belgium

    Loïc Fonkoué, Catherine Behets & Maude Coyette

  3. Department of Orthopedics and Trauma, Cliniques Universitaires St-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium

    Emmanuel Thienpont & Olivier Cornu

Authors
  1. Loïc Fonkoué
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  2. Catherine Behets
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  3. Jean-Éric K. Kouassi
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  4. Maude Coyette
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  5. Christine Detrembleur
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  6. Emmanuel Thienpont
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  7. Olivier Cornu
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Contributions

LF: protocol development, data collection, data analysis, manuscript writing. CB: protocol development, data analysis, manuscript revision. J-EKK: data collection, manuscript revision. MC: manuscript revision. CD: manuscript revision. ET: manuscript revision. OC: project development, data analysis, manuscript revision.

Corresponding author

Correspondence to Loïc Fonkoué.

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The authors declare that they have no conflict of interest.

Human and animal rights

This article does not contain any study with human participants performed by any of the authors, but it involved human cadavers.

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Fonkoué, L., Behets, C., Kouassi, JÉ.K. et al. Distribution of sensory nerves supplying the knee joint capsule and implications for genicular blockade and radiofrequency ablation: an anatomical study. Surg Radiol Anat 41, 1461–1471 (2019). https://doi.org/10.1007/s00276-019-02291-y

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  • DOI: https://doi.org/10.1007/s00276-019-02291-y

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