Saphenous and Infrapatellar Nerves at the Adductor Canal: Anatomy and Implications in Regional Anesthesia

Anagnostopoulou, Sofia; Anagnostis, G.; Saranteas, Theodosios; Mavrogenis, Andreas F.; Paraskeuopoulos, Tilemachos

doi:10.3928/01477447-20160129-03

Cited by 19 publications

(19 citation statements)

References 14 publications

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“…It is encased by an aponeurosis, and its contents include the femoral artery and vein, a sensory branch of the obturator nerve, the saphenous nerve, and the motor nerve to the vastus medialis. 2 Thus, with ACB, paralysis of the vastus medialis is possible. Adoni et al 1 demonstrated a 36% decrease in short-term vastus medialis strength in patients who underwent “typical” ACB but no strength reduction in patients who received a more distal saphenous nerve block.…”

Section: Discussionmentioning

confidence: 99%

Isokinetic Strength Deficit 6 Months After Adductor Canal Blockade for Anterior Cruciate Ligament Reconstruction

Christensen

Taylor

Hetzel

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Recent evidence shows a delayed return to sport in children and delayed quadriceps recovery in both adults and children who have undergone anterior cruciate ligament (ACL) reconstruction with concomitant femoral nerve blockade (FNB) compared with those who had no blockade. We evaluated the use of adductor canal blockade (ACB), as an alternative to FNB, at the time of ACL reconstruction.Hypothesis:Patients who receive ACB will have greater isokinetic strength at 6 months postoperative compared with patients who receive FNB at the time of ACL reconstruction.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective record review was performed at a single academic medical center to identify all patients aged ≥16 years who had undergone ACL reconstruction with blockade between January 2010 and January 2015. Exclusion criteria included (1) non–sports medicine fellowship–trained surgeon performing the procedure, (2) continuous nerve catheter or concurrent epidural used, (3) revision ACL reconstruction or multiligament reconstruction as the index procedure, (4) previous contralateral ACL reconstruction, (5) concurrent microfracture, and (6) additional surgery within the 6-month outcome period that affected recovery. Isokinetic strength testing was performed using a computerized dynamometer, measuring total work at fast speed and peak torque at slow speed at 6 months; results were evaluated as a percentage of the nonoperative side. Multivariate regression analysis was used to evaluate the effect of block type on isokinetic strength outcome variables, controlling for age, sex, body mass index, graft type, and surgeon.Results:There were 230 patients receiving FNB and 30 patients receiving ACB included in the study. The multivariate regression analysis identified a greater side-to-side deficit in extension total work for the ACB group compared with the FNB group (P = .040), after controlling for age, sex, body mass index, graft type, and surgeon.Conclusion:Compared with FNB, ACB for ACL reconstruction is associated with a persistent fast-activation isokinetic strength deficit at 6 months after surgery. This is the first study to compare FNB to ACB, and results are concerning for patients planning an early return to sport.

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Section: Discussionmentioning

confidence: 99%

Isokinetic Strength Deficit 6 Months After Adductor Canal Blockade for Anterior Cruciate Ligament Reconstruction

Christensen

Taylor

Hetzel

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…The midpoint between the ASIS and the base of the patella is located at the level of the FT in most human beings. [13][14][15][16] In a recent dissection study, the main find was that the proximal opening of the AC was distal to the midpoint FIGURE 1. The figure shows the medial thigh with the sharply demarcated intersection (red arrowhead) between the medial margins of the sartorius (1) and adductor longus (2) muscles.…”

Section: The Location Of the "Adductor Canal" In The Thighmentioning

confidence: 99%

“…of the thigh from ASIS to base of patella in 13 of 17 specimens (mean distance, 6.5 cm). 16 Periarterial injection anterolateral to the FA midway between the ASIS and the base of the patella is best labeled a "Femoral Triangle Block." In our opinion, the term "Adductor Canal Block" should be reserved exclusively to describe an injection directly into the AC proper ( Fig.…”

Section: The Location Of the "Adductor Canal" In The Thighmentioning

confidence: 99%

The Optimal Analgesic Block for Total Knee Arthroplasty

Bendtsen

Moriggl

Chan

et al. 2016

Regional Anesthesia and Pain Medicine

117

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“…Anagnostopoulou et al concluded that the "superior foramen of the AC" (corresponding to the superior border of AC) was at a mean distance of 6.5 cm from the midpoint of thigh. 15 In an earlier study, Horn et al found the median distance from the proximal patella to the distal end of AC was 10.25 cm (7 to 11.5 cm). 16 In a recent cadaver study, Elazab et al described a continuous layer of subsartorial fascia called the fascia vasto-adductoria in the midthigh.…”

Section: Discussionmentioning

confidence: 94%

Adductor Canal Blocks: An Observational Ultrasound Study in Volunteers to Identify the Relationship of the True Adductor Canal to Commonly Described Block Approaches and a Review of the Literature

Ranganath¹,

Yap²,

Wong³

et al. 2019

Preprint

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Background There is controversy over the site at which the ultrasound-guided adductor canal blocks (ACB) should be performed, and the anatomic relationship of these sites to the true adductor canal (AC). Most studies describe performing the ACB at the anatomical mid-point of the thigh (mid-thigh ACB, mtACB), or 2-3 cm above the inferior border of AC (distal ACB, dACB). The aim of the study was to determine the relationship of these approaches to the true anatomical AC in volunteers. Methods Using ultrasonography and surface landmarks, we characterized the AC anatomy of both lower limbs in 60 adult volunteers (30 males, 30 females). The primary outcome variable was the distance from the mid-thigh approach to the superior border of AC. Calculated secondary measurements were the distance between the 2 approaches and the length of AC. Results The (median [IQR]) needle entry point for mtACB was above the superior border of the AC in both males (5.5 cm [4.6-7.0]) and females (6.6 cm [5.8-7.3]) (P = 0.045 [95% CI of the difference in medians, -1.63 to 0.00 cm]). The median distance between the needle entry points of mtACB and dACB in males vs females were not different (median difference: 0.63 cm; 95% CI, -0.25 to 1.50). The length of the adductor canal was 1.5 cm longer in males compared to females (95% CI, 1.00 to 2.25 cm) Conclusions AC blocks performed at mid-thigh or more proximal are outside the anatomical adductor canal. A review of recent literature shows 3 different sites where AC blocks are performed; the majority of the blocks are performed in the mid-thigh region and hence outside of the true adductor canal.

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Saphenous and Infrapatellar Nerves at the Adductor Canal: Anatomy and Implications in Regional Anesthesia

Cited by 19 publications

References 14 publications

Isokinetic Strength Deficit 6 Months After Adductor Canal Blockade for Anterior Cruciate Ligament Reconstruction

Isokinetic Strength Deficit 6 Months After Adductor Canal Blockade for Anterior Cruciate Ligament Reconstruction

The Optimal Analgesic Block for Total Knee Arthroplasty

Adductor Canal Blocks: An Observational Ultrasound Study in Volunteers to Identify the Relationship of the True Adductor Canal to Commonly Described Block Approaches and a Review of the Literature

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