Background: Neuromata formation in the infrapatellar branches 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 anatomical landmarks are the standard for intra-operative localization of IPBSN neuromas.
Objective: To demonstrate the anatomy of the IPSBN and the use of pre-operative ultrasound and needle placement for localization of the nerve prior to sectioning.
Methods: Using both anatomical dissections and the combination of pre-operative ultrasound and curved needle placement, we demonstrate the technical nuances to localize the IPBSN prior to operative section.
Results: Cadaveric dissection is used to illustrate the main trunk of the IPSBN and its branches. In two 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.
From: Ultrasound-guided Needle Localization of the Saphenous Nerve for Removal of Neuroma in the Infrapatellar Branches: Technical Report by Jose et al.