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Innervation of the Anterior Capsule of the Human Knee: Implications for Radiofrequency Ablation
  1. Carlo D. Franco, MD*,,
  2. Asokumar Buvanendran, MD*,
  3. Jeffrey D. Petersohn, MD,
  4. Robert D. Menzies, MD§ and
  5. Linda Pham Menzies, MD§
  1. From the *Department of Anesthesiology and Pain Management, Rush University Medical Center; and †Department of Anesthesiology and Pain Management, JHS Hospital of Cook County, Chicago, IL; ‡Department of Anesthesiology, Drexel University College of Medicine, Philadelphia, PA; and §JPS Sports Medicine and Orthopedics, Arlington, TX
  1. Address correspondence to: Carlo D. Franco, MD, Department of Anesthesiology and Pain Management, John H. Stroger Jr Hospital of Cook County, 1901 W Harrison St, Chicago, IL 60612 (e-mail: carlofra{at}aol.com).

Abstract

Background and Objectives Chronic knee pain is common in all age groups. Some patients who fail conservative therapy benefit from radiofrequency neurotomy. Knowledge of the anatomy is critical to ensure a successful outcome. The purpose of this study was to reanalyze the innervation to the anterior knee capsule from the perspective of the interventional pain practitioner.

Methods The study included a comprehensive literature review followed by dissection of 8 human knees to identify the primary capsular innervation of the anterior knee joint. Photographs and measurements were obtained for each relevant nerve branch. Stainless-steel wires were placed along the course of each primary innervation, and radiographs were obtained.

Results Literature review revealed a lack of consensus on the number and origin of nerve branches innervating the anterior knee capsule. All dissections revealed the following 6 nerves: superolateral branch from the vastus lateralis, superomedial branch from the vastus medialis, middle branch from the vastus intermedius, inferolateral (recurrent) branch from the common peroneal nerve, inferomedial branch from the saphenous nerve, and a lateral articular nerve branch from the common peroneal nerve.

Nerve branches showed variable proximal trajectories but constant distal points of contact with femur and tibia. The inferolateral peroneal nerve branch was found to be too close to the common peroneal nerve, making it inappropriate for radiofrequency neurotomy.

Conclusions The innervation of the anterior capsule of the knee joint seems to follow a constant pattern making at least 3 of these nerves accessible to percutaneous ablation. To optimize clinical outcome, well-aligned radiographs are critical to guide lesion placement.

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Footnotes

  • Conflicts of Interest and Source of Funding: Kimberly Clark (now Halyard Health) provided funding for the cadavers and organizational support to accomplish great part of this work but had no influence on the interpretation of data and preparation of the manuscript. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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