Jean Jose1, Marvin K Smith, Lee D Kaplan, Bryson P Lesniak, Allan D Levi. 1. *Department of Radiology and The Miami Project to Cure Paralysis, University of Miami, Miller School of Medicine, Miami, Florida; ‡UHealth Sports Performance and Wellness Institute, University of Miami, Miller School of Medicine, Miami, Florida; §Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami, Miller School of Medicine, Miami, Florida.
Abstract
BACKGROUND: Neuromata formation in the infrapatellar branch of the saphenous nerve (IPBSN) has been well described as a potential complication of arthroscopic knee surgery and knee trauma. Resection has been proven to provide improvement of pain and increased range of motion. Currently, physical examination and surgical exploration based on anatomic landmarks are the standard for intraoperative localization of IPBSN neuromas. OBJECTIVE: To demonstrate the anatomy of the IPSBN and the use of preoperative ultrasound and needle placement for localization of the nerve before sectioning. METHODS: Using both anatomic dissections and the combination of preoperative ultrasound and curved-needle placement, we demonstrate the technical nuances to localize the IPBSN before operative section. RESULTS: Cadaveric dissection is used to illustrate the main trunk of the IPSBN and its branches. In 2 cases, ultrasound guidance was effectively used to localize the saphenous nerve and its branches and facilitate the operative treatment of patients with symptomatic IPBSN neuromas. CONCLUSION: Ultrasound is a widely accepted and commonly utilized imaging modality; however, in this report, ultrasound-guided needle localization was used to aid in the resection of neuromas of small, painful sensory nerves.
BACKGROUND: Neuromata formation in the infrapatellar branch of the saphenous nerve (IPBSN) has been well described as a potential complication of arthroscopic knee surgery and knee trauma. Resection has been proven to provide improvement of pain and increased range of motion. Currently, physical examination and surgical exploration based on anatomic landmarks are the standard for intraoperative localization of IPBSN neuromas. OBJECTIVE: To demonstrate the anatomy of the IPSBN and the use of preoperative ultrasound and needle placement for localization of the nerve before sectioning. METHODS: Using both anatomic dissections and the combination of preoperative ultrasound and curved-needle placement, we demonstrate the technical nuances to localize the IPBSN before operative section. RESULTS: Cadaveric dissection is used to illustrate the main trunk of the IPSBN and its branches. In 2 cases, ultrasound guidance was effectively used to localize the saphenous nerve and its branches and facilitate the operative treatment of patients with symptomatic IPBSN neuromas. CONCLUSION: Ultrasound is a widely accepted and commonly utilized imaging modality; however, in this report, ultrasound-guided needle localization was used to aid in the resection of neuromas of small, painful sensory nerves.
Authors: Brandon Michael Henry; Krzysztof A Tomaszewski; Przemysław A Pękala; Matthew J Graves; Jakub R Pękala; Beatrice Sanna; Ewa Mizia Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-06-01 Impact factor: 4.342