Suresh Rachana, Buddhiraju Anirudh, Kuo Keith, Dellon A Lee, Tuffaha Sami, Williams Eric
Johns Hopkins Medicine, Baltimore, USA.
University of Utah, Salt Lake City, USA.
Arch Orthop Trauma Surg. 2025 Mar 24;145(1):211. doi: 10.1007/s00402-025-05820-0.
Anterior knee pain can significantly affect the quality of life of those living with it. One approach to addressing anterior knee pain involves the selective denervation of the patella to reduce afferent pain transmission, but there has been no consensus on the number, location, or origin of the nerves innervating the patella. In this study, we review existing literature on anterior knee innervation and present findings from our cadaveric dissection to provide a detailed description of the innervation of the anterior knee joint.
Two independent authors reviewed the literature on anterior knee innervation from PubMed and Embase, and a sub-search was conducted on the relationship between the infrapatellar branch of the saphenous nerve (IPBSN) and the anterior knee compartment. Subsequently, two fresh-frozen cadavers were dissected to determine whether the saphenous nerve innervates the anterior knee compartment and to confirm, through tissue biopsies stained with laminin and beta-III-tubulin, whether previously described nerves innervate the patella.
A total of 463 and 304 entries on patellar innervation and saphenous nerve anatomy, respectively, were identified through PubMed and Embase. Descriptions of the nerves innervating the patella were found to be inconsistent and are summarized. No studies identified branches of the IPBSN directly innervating the patella or patellar tendon. On cadaveric dissection, we found that anterior knee innervation comprised the nerves within the distal vastus medialis and lateralis muscles, the medial and lateral retinacular nerves, and occasionally a branch of the IPBSN that innervated the inferomedial anterior knee skin.
This study is the first to provide histological confirmation of patellar innervation by the IPBSN. Our findings suggest that an approach based on a positive response to differential nerve blocks, followed by resection of the nerves implicated in that anterior compartment knee pain, may be more effective in treating persistent anterior knee pain than circumferential electroablation of the patella or routine resection of the IPBSN.
Level III.
膝前疼痛会显著影响患者的生活质量。解决膝前疼痛的一种方法是选择性地对髌骨进行去神经支配，以减少传入性疼痛传递，但对于支配髌骨的神经数量、位置或来源尚无共识。在本研究中，我们回顾了关于膝前神经支配的现有文献，并展示了尸体解剖的结果，以详细描述膝关节前部的神经支配情况。
两位独立作者检索了PubMed和Embase上关于膝前神经支配的文献，并对隐神经髌下支（IPBSN）与膝前间隙的关系进行了子检索。随后，解剖了两具新鲜冷冻尸体，以确定隐神经是否支配膝前间隙，并通过用层粘连蛋白和β-III-微管蛋白染色的组织活检来确认先前描述的神经是否支配髌骨。
通过PubMed和Embase分别检索到463篇和304篇关于髌骨神经支配和隐神经解剖的文献。发现关于支配髌骨神经的描述不一致，并进行了总结。没有研究发现IPBSN的分支直接支配髌骨或髌腱。在尸体解剖中，我们发现膝前神经支配包括股内侧肌和股外侧肌远端内的神经、髌内和髌外侧支持带神经，偶尔还有一支IPBSN分支支配膝前内下皮肤。
本研究首次提供了IPBSN对髌骨神经支配的组织学证实。我们的研究结果表明，基于对差异神经阻滞的阳性反应，随后切除与膝前间隙疼痛相关的神经的方法，可能比髌骨周围电灼或常规切除IPBSN在治疗持续性膝前疼痛方面更有效。
三级。
