Injury to Infrapatellar Branch of Saphenous Nerve in Arthroscopic Knee Surgery

Retropatellar Accessory Portals for Improved Access to the Patella; Anatomic Description and Evaluation of Safety

“…The relationship between the IPBSN and the midpatella was not significantly different when comparing measurements from left knees (mean, 57.7 ± 19.3) to right knees (mean, 57.3 ± 16.4) in this study (t(8) ¼ 0.03; P ¼ .98) nor when compared with the study by Mochida and Kikuchi 24 (left knees: mean, 52.2 ± 12.4; t(71) ¼ 0.86; P ¼ .39; right knees: mean, 54.2 ± 12.3; t(64) ¼ 0.68; P ¼ .68). The relationship between the IPBSN and the medial epicondyle was also not significantly different when comparing measurements from left knees (mean, 12.7 ± 11.1) to right knees (mean, 15.5 ± 3.3) in this study (t(8) ¼ 0.43; P ¼ .68).…”

“…5,9,15 After piercing the sartorious and deep fascia, it follows a highly variable path curving medially and anteroinferiorly over the knee. 14,15,24 Iatrogenic damage to the IPBSN has been reported after many procedures, including total knee arthroplasty, arthrotomy, anterior cruciate ligament reconstruction, open meniscectomy, resection of the prepatellar bursa, retrograde femoral nailing, tibial nailing, and even arthroscopy using standard portals. 9,14,16 Mochida and Kikuchi 24 recognized the precarious position of the IPBSN during standard knee arthroscopy and were the first to evaluate the risk its variable branching pattern imposed.…”

“…Two-sample t tests were used in some instances to evaluate relevant left-versus-right anatomic relationships and compared with another published study. 24 The level of significance for these tests was always a < 0.05.…”

Hypesthesia after Anterolateral versus Midline Skin Incision in TKA: A Randomized Study

“…For some authors [41], however, saphenous nerve injury does not appear to be a major concern after TKA. A midline or an anteromedial skin approach implies an almost inevitable section of the infrapatellar branch of the saphenous nerve [16,27,32,33,42]. Numerous prospective [31] or retrospective studies [8,16,20,41] report hypesthesias after an anteromedial or midline skin incision (Table 5).…”

“…However, this recovery is limited and sensory disturbances may be permanent [26,41,42]. Moreover, nerve injury may be complicated by the occurrence of neuromas [26,32,36,42], which may require additional interventions [10,36]. The risk is even greater when the nerve is injured closer to its origin [26].…”