Anatomic and Ultrasonographic Evaluation of the Knee Sensory Innervation

Valls, Jorge Manuel Orduña; Vallejo, Ricardo; Pais, Pablo López; Soto, Eliezer; Rodríguez, Daniel Torres; Cedeño, David L.; Tornero, Carlos; Rodríguez, Maximino Quintáns; Baluja, Aurora; Escudero, J. Álvarez

doi:10.1097/aap.0000000000000516

Cited by 69 publications

(31 citation statements)

References 22 publications

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“…Finally, the length, width and thickness of the semitendinosus, gracilis, sartorius tendons were measured, as well as the distance between the intersection and the tibial attachment of pes anserinus. We repeated examination procedures twice by the same technician to ensure consistency of the data [ 15 – 19 ] (as shown in Fig. 2 ).…”

Section: Methodsmentioning

confidence: 99%

The anatomical and imaging study of pes anserinus and its clinical application

Zhong

Wang

et al. 2018

Medicine

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Section: Methodsmentioning

confidence: 99%

The anatomical and imaging study of pes anserinus and its clinical application

Zhong

Wang

et al. 2018

Medicine

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“…[ 11 ] However, localising the genicular nerves can be difficult because of anatomical variations. [ 12 ],[ 13 ] Added to this, the procedure can be distressing when during localisation of genicular nerves the RF cannula comes in contact with pain-sensitive structures such as the periosteum and ligament insertion sites. [ 14 ] These limitations can be partly overcome using bipolar RF.…”

Section: Discussionmentioning

confidence: 99%

“…[ 18 ] Recently, ultrasound guidance has been used to locate the genicular nerves with improved success rates even in the situation of tremendous variabilities in the anatomy of the nerves. [ 12 ],[ 19 ] However, both techniques require sophisticated equipment and have a learning curve before one becomes equipped with the procedure.…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of monopolar and bipolar radiofrequency ablation of genicular nerves in chronic knee pain due to osteoarthritis

et al. 2018

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Background and Aims:Monopolar radiofrequency ablation (MRFA) of the genicular nerve is effective in managing chronic knee pain from osteoarthritis (OA); however, the procedure itself is associated with significant pain due to manipulation of electrode to localise tiny genicular nerves. We hypothesised that inserting two electrodes to target the genicular nerves [bipolar radiofrequency ablation (BRFA)] without sensory localisation can decrease the procedural pain with equal analgesic efficacy in treating knee pain.Methods:Thirty patients with chronic knee pain due to OA were randomised to receive either MRFA (n = 15) or BRFA (n = 15), after having 50% pain relief with diagnostic genicular nerve block. Pain during the procedure (assessed by the Numeric Rating Scale [NRS]), time taken to do the procedure and complications were recorded. Knee pain was assessed by the Oxford Knee Score at baseline, 1 week, 1 month, 3 months and 6 months following the procedure.Results:Patients in both groups had good pain relief, and no difference in pain relief and the duration of pain relief was seen between the two groups. The median (range) NRS for procedural pain was significantly lower in the bipolar group [3 (3–5)] than in the monopolar group [5 (3–7), P = 0.013]. There was no significant difference in procedure time and no complications were seen in either group.Conclusion:BRFA is an effective alternative for ablation of genicular nerves in patients with knee pain due to OA. It causes less procedural pain compared with MRFA.

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“…[ 1 2 3 ] to regional blocks like the Femoral, sciatic, Adductor, combined femoral and sciatic[ 4 5 6 ] for targeting pain free TKA has paved way to more and more research into the subject. As the knee joint is supplied by various nerves (genicular nerves) from the femoral, obturator and sciatic nerves[ 7 ] hence needs a comprehensive yet simple technique for complete analgesia postoperatively. In this series, the authors have revisited and modified Roy et al .…”

Section: Introductionmentioning

confidence: 99%

Total postoperative analgesia for total knee arthroplasty: ultrasound guided single injection modified 4 in 1 block

Roy

Agarwal

Pradhan

et al. 2020

J Anaesthesiol Clin Pharmacol

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Background and Aims: Total pain free outcome following total knee arthroplasty has led to the evolution of regional blocks. In this series, the authors have revisited and modified Roy et al . 's technique of Ultrasound guided 4 in 1 block for knee and below knee surgeries, to provide a complete comprehensive yet simple single injection technique for postoperative analgesia for Total Knee Arthroplasty (TKA). Material and Methods: After Instituional ethics approval, we performed the modified 4 in 1 block on 10 consenting patients scheduled to undergo total knee arthroplasty. A linear USG-probe was used to identify medial femoral condyle, then vastus and sartorius intersection was identified. The probe was slid till the descending genicular artery branching from superficial femoral artery was visualized proximal to hiatus. At this point the needle with PNS attached, was guided into the Vastus medialis muscle till the stimulation of the nerve to Vastus medialis (0.4-0.5 mA). At this point 5–7 mL of 0.2% Ropivacaine was injected. The needle was guided in plane to perivascular region and after negative aspiration 0.2%ropivacaine 20–25 ml was injected, visualised to push the femoral artery. Results: All ten patients considered in this study had an optimum pain score of <5 and were comfortable along with no quadriceps weakness, except one patient had a pain score of more than 5 after 36 hr post-operatively and required rescue analgesia. Conclusion: The addition of USG and PNS guided Vastus medialis nerve block to USG 4-in-1 block in the technique gives good post-operative analgesia for TKA.

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Anatomic and Ultrasonographic Evaluation of the Knee Sensory Innervation

Cited by 69 publications

References 22 publications

The anatomical and imaging study of pes anserinus and its clinical application

The anatomical and imaging study of pes anserinus and its clinical application

Comparative evaluation of monopolar and bipolar radiofrequency ablation of genicular nerves in chronic knee pain due to osteoarthritis

Total postoperative analgesia for total knee arthroplasty: ultrasound guided single injection modified 4 in 1 block

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