Knee pain and the infrapatellar branch of the saphenous nerve

Orthopaedic Department, Royal Free Hospital, London, UK.
Journal of the Royal Society of Medicine (Impact Factor: 2.12). 12/1998; 91(11):573-5.
Source: PubMed


Pain over the front of the knee is common after surgery or trauma but often a definite diagnosis is difficult to make. Over the past year we have seen five cases in which the pain could be ascribed to damage to a branch of the infrapatellar branch of the saphenous nerve. Two were subsequent to trauma and three to surgical procedures. In all five cases surgical exploration gave symptomatic relief. Eight cadaveric knees were prosected to explore further the anatomy of this nerve in relation to the injuries. Injury to one of these branches should be considered in cases of persistent anterior, anteromedial or anterolateral knee pain or neurological symptoms following surgery or trauma.

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    • "Cases of saphenous neuritis are well documented and have been attributed to trauma, surgery, and nerve entrapment. Tennent et al. (1998) reported cases of blunt trauma to the knee leading to numbness and hypersensitivity, relieved by anesthetic injections. Sensory disturbances after knee surgery have been reported to be as high as 22.2%, emphasizing the importance of understanding the location and variations that the saphenous nerve and its *Correspondence to: Jonathan J. "

    Full-text · Article · Nov 2011 · Clinical Anatomy
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    ABSTRACT: Generally infrapatellar region is innervated by the infrapatellar branch of the saphenous nerve and the branches of medial cutaneous femoral nerve that form a plexus so called subsartorial plexus. We found that saphenous nerve after leaving the adductor canal did not give an infrapatellar branch but the whole sensory nerves of the infrapatellar region were originat- ing from medial cutaneous femoral nerve in a cadaver. A detailed anatomic knowledge about the innervation of the infra- patellar region is mandatory for knee surgeons. Surgeons should always consider the extreme variability of infrapatellar innervation and should pay extra attention to protect the innervating nerve during dissection.
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    ABSTRACT: Persistent anterior knee pain, especially after surgery, can be very frustrating for the patient and the clinician. Injury to the infrapatellar branch of the saphenous nerve (IPS) is not uncommon after knee surgeries and trauma, yet the diagnosis and treatment of IPS neuralgia is not usually taught in pain training programs. In this case report, we describe the anatomy of the saphenous nerve and specifically the infrapatellar saphenous nerve branch; we also discuss the types of surgical trauma, the clinical presentation, the diagnostic modalities, the diagnostic injection technique, and the treatment options. As early as 1945, surgeons were cautioned regarding the potential surgical trauma to the IPS. Although many authors dismissed the nerve damage as unavoidable, the IPS is now recognized as a potential cause of persistent anterior and anteriomedial knee pain. Even more concerning, damage to peripheral nerves such as the IPS has been identified as the cause and potential perpetuating factor for conditions such as complex regional pain syndromes (CRPS). Because the clinical presentation may be vague, it has often been misdiagnosed and underdiagnosed. There is a documented vasomotor instability, but, unfortunately, sympathetic blocks will not address the underlying pathology, and therefore patients often will not respond to this modality, although the correct diagnosis can lead to rapid and gratifying resolution of the pathology. An entity unknown to the clinician is never diagnosed, and so it is important to familiarize pain physicians with IPS neuropathy so that they may be able to offer assistance when this painful condition arises.
    Full-text · Article · May 2013 · Pain physician
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