Calderón-Díez Laura, Belón-Pérez Pedro, Fernández-de-Las-Peñas César, Sánchez-Sánchez José L
Department of Anatomy and Histology, Faculty of Medicine, Universidad de Salamanca, 37007 Salamanca, Spain.
Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain.
J Funct Morphol Kinesiol. 2025 Jun 3;10(2):208. doi: 10.3390/jfmk10020208.
Patellar tendinopathy is a musculoskeletal pain condition capable of impairing physical or sport activities. Preliminary evidence supports the efficacy of percutaneous electrolysis (PE) in reducing pain and related disability in patients with patellar tendinopathy.
This study proposes a theoretical model for the application of a percutaneous electrolysis approach targeting the deep zone of the proximal and distal parts of the patellar tendon in both human (ultrasound-guided) and fresh cadaver (not ultrasound-guided) models.
A filiform solid needle was inserted from the lateral side of the patellar tendon targeting two areas: 1, the deep proximal interface of the Hoffa's fat pad; and 2, the distal insertion of the patellar tendon at the tibial tuberosity in 10 fresh cadavers and in 10 healthy individuals. The patellar tendon, the saphenous nerve, and the infrapatellar nerve and its branches were identified by dissecting fresh cadavers to determine the anatomical trajectory of the infrapatellar nerve branches in relation to the needle.
The cadaveric model shows an anatomical relationship between the patellar tendon and infrapatellar nerve branches at the medial part of the knee. Infrapatellar nerve branches ran subcutaneously obliquely from the medial to the anterior and lateral parts of the knee, crossing in front of the patellar tendon. In all cadavers, the superior and inferior infrapatellar branches ran through the superior or inferior parts of the medial knee area. Only in 2/10 knees infrapatellar nerve branches reached the lateral part of the knee, specifically the superior lateral part. No neurovascular bundle of infrapatellar nerve branches was pierced in any insertion when the needle was inserted from the lateral part of the knee.
This anatomical model supports the use of a lateral approach as a potentially safe approach to apply in needling interventions, e.g., percutaneous electrolysis for patellar tendinopathies. The infrapatellar nerve branches are vulnerable to needle procedures applied through the anteromedial side of the knee.
髌腱病是一种可损害身体活动或体育活动的肌肉骨骼疼痛病症。初步证据支持经皮电解（PE）在减轻髌腱病患者疼痛及相关功能障碍方面的疗效。
本研究针对人类（超声引导）和新鲜尸体（非超声引导）模型，提出一种经皮电解方法应用于髌腱近端和远端深部区域的理论模型。
在10具新鲜尸体和10名健康个体中，从髌腱外侧插入一根丝状实心针，目标区域为：1，Hoffa脂肪垫的深部近端界面；2，髌腱在胫骨结节处的远端附着点。通过解剖新鲜尸体来确定髌下神经分支相对于针的解剖轨迹，从而识别髌腱、隐神经、髌下神经及其分支。
尸体模型显示了膝关节内侧髌腱与髌下神经分支之间的解剖关系。髌下神经分支在皮下从膝关节内侧斜向前外侧走行，在髌腱前方交叉。在所有尸体中，髌下上支和下支穿过膝关节内侧区域的上部或下部。仅在2/10的膝关节中，髌下神经分支到达膝关节外侧部分，特别是上外侧部分。当从膝关节外侧插入针时，在任何穿刺点均未刺破髌下神经分支的神经血管束。
该解剖模型支持将外侧入路作为一种潜在安全的入路应用于针刺干预，例如用于髌腱病的经皮电解。髌下神经分支易受通过膝关节前内侧进行的针刺操作的影响。
