The Anterior Branch of the Medial Femoral Cutaneous Nerve Innervates Cutaneous and Deep Surgical Incisions in Total Knee Arthroplasty.

Autor: Bjørn S; Department of Clinical Medicine, Faculty of Health, Aarhus University, 8200 Aarhus, Denmark.; Department of Anesthesiology, Aarhus University Hospital, 8200 Aarhus, Denmark., Nielsen TD; Department of Anesthesiology, Aarhus University Hospital, 8200 Aarhus, Denmark., Jensen AE; Department of Clinical Medicine, Faculty of Health, Aarhus University, 8200 Aarhus, Denmark., Jessen C; Department of Clinical Medicine, Faculty of Health, Aarhus University, 8200 Aarhus, Denmark.; Department of Anesthesiology, Horsens Regional Hospital, 8700 Horsens, Denmark., Kolsen-Petersen JA; Department of Clinical Medicine, Faculty of Health, Aarhus University, 8200 Aarhus, Denmark.; Department of Anesthesiology, Aarhus University Hospital, 8200 Aarhus, Denmark., Moriggl B; Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, 6020 Innsbruck, Austria., Hoermann R; Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, 6020 Innsbruck, Austria., Bendtsen TF; Department of Clinical Medicine, Faculty of Health, Aarhus University, 8200 Aarhus, Denmark.; Department of Anesthesiology, Aarhus University Hospital, 8200 Aarhus, Denmark.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2024 May 31; Vol. 13 (11). Date of Electronic Publication: 2024 May 31.
DOI: 10.3390/jcm13113270
Abstrakt: Background/Objectives: The intermediate femoral cutaneous nerve (IFCN), the saphenous nerve, and the medial femoral cutaneous nerve (MFCN) innervate the skin of the anteromedial knee region. However, it is unknown whether the MFCN has a deeper innervation. This would be relevant for total knee arthroplasty (TKA) that intersects deeper anteromedial genicular tissue layers. Primary aim: to investigate deeper innervation of the anterior and posterior MFCN branches (MFCN-A and MFCN-P). Secondary aim: to investigate MFCN innervation of the skin covering the anteromedial knee area and medial parapatellar arthrotomy used for TKA. Methods: This study consists of (1) a dissection study and (2) unpublished data and post hoc analysis from a randomized controlled double-blinded volunteer trial (EudraCT number: 2020-004942-12). All volunteers received bilateral active IFCN blocks (nerve block round 1) and saphenous nerve blocks (nerve block round 2). In nerve block round 3, all volunteers were allocated to a selective MFCN-A block. Results: (1) The MFCN-A consistently innervated deeper structures in the anteromedial knee region in all dissected specimens. No deep innervation from the MFCN-P was observed. (2) Sixteen out of nineteen volunteers had an unanesthetized skin gap in the anteromedial knee area and eleven out of the nineteen volunteers had an unanesthetized gap on the skin covering the medial parapatellar arthrotomy before the active MFCN-A block. The anteromedial knee area and medial parapatellar arthrotomy was completely anesthetized after the MFCN-A block in 75% and 82% of cases, respectively. Conclusions: The MFCN-A shows consistent deep innervation in the anteromedial knee region and the area of MFCN-A innervation overlaps the skin area covering the medial parapatellar arthrotomy. Further trials are mandated to investigate whether an MFCN-A block translates into a clinical effect on postoperative pain after total knee arthroplasty or can be used for diagnosis and interventional pain management for chronic neuropathic pain due to damage to the MFCN-A during surgery.
Databáze: MEDLINE
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