title: Innervation of the Anterior Capsule of the Human Knee: Implications for Radiofrequency Ablation.
abstract: OBJECTIVE
  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.
authors.affiliation: 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.
authors.forename: Carlo D
authors.initials: CD
authors.lastname: Franco
authors.forename: Asokumar
authors.initials: A
authors.lastname: Buvanendran
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Petersohn
authors.forename: Robert D
authors.initials: RD
authors.lastname: Menzies
authors.forename: Linda Pham
authors.initials: LP
authors.lastname: Menzies
mesh_terms: D059925:Anatomic Landmarks; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004210:Dissection; D006801:Humans; D017746:Joint Capsule / Q000000981:diagnostic imaging / Q000294:innervation* / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000294:innervation* / Q000601:surgery*; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000517:prevention & control; D011859:Radiography