Anatomical Study of the Innervation of Anterior Knee Joint Capsule: Implication for Image-Guided Intervention
Anatomical Study of the Innervation of Anterior Knee Joint Capsule: Implication for Image-Guided Intervention
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DOI：
10.1097/aap.0000000000000778
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发表时间：
2018-05-01
影响因子：
5.1
通讯作者：
Gofeld, Michael
中科院分区：
文献类型：
--
作者：
Tran, John;Peng, Philip W. H.;Gofeld, Michael
背景和目的膝关节是骨性关节炎最常见的部位。虽然关节置换被认为是最终的解决方案，但在某些情况下可以考虑射频去神经治疗。射频消融需要精确定位支配关节囊的关节分支。本身体研究的目的是确定支配膝关节前关节囊的关节分支的来源、走行、关系和频率。记录关节支的数目和来源，并用象限定义其分布。结果关节支终止于4个象限中的1个，重叠最小。所有标本的上外侧象限由股外侧神经、股中间神经、膝上外侧神经和腓总神经支配，外侧以下由膝外侧下神经和腓骨返神经支配，股内侧神经、股中间神经和膝内上神经支配内侧上，膝内侧下神经支配内侧下神经。在3例标本中，内侧下象限也有隐神经髌下支的神经支配。除股外侧和股内侧神经外，其余各关节支均位于骨膜水平。结论关节支的频率图为制定膝关节射频去神经和围手术期疼痛治疗的新方案提供了解剖学基础。
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.