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Duke Orthopaedics
Wheeless' Textbook of Orthopaedics

Saphenous Nerve

- Discussion:  (Innervation of the Leg and Foot)
    - arises from femoral nerve in femoral triangle and descends through it on lateral side of the femoral vessels to enter the adductor canal.
    - it crosses the vessels obliquely to lie on their medial side in front of lower end of adductor magnus  muscle;
    - nerve continues its descent on medial side of knee, pierces fascia lata between tendons of sartorius & gracilis, & then passes downward on
            medial side of leg close to greater saphenous  vein;
    - at lower end of canal, it leaves femoral vessels & gives off its infrapatellar branch, & runs onward to supply skin over medial side and front of knee and patellar ligament
    - saphenous nerve lies posterior to sartorius in 60%; 
    - sartorial branch: lies posterior to the sartorius;
    - infrapatellar branch
nerve exits the adductor canal and travels to the anteromedial aspect of the knee;
    - position relative to the fascia: at the level of the knee the nerve will be extrafascial in 43%
    - in the lower leg, it subdivides:
            - one branch follows the medial tibial border to the level of the ankle.
            - larger passes anterior to medial malleolus to innervate skin on medial and dorsal side foot;
    - changes in Nerve Position w/ Knee Flexion:
            - in extension, saphenous nerve & all infrapatellar branches cross medial joint line anterior to posteromedial corner & are located 2-3 cm 
                     anterior to semitendinosus tendon;
            - in flexed knee, saphenous nerve and its branches cross medial joint line at, or slightly behind, posteromedial corner of knee;

- Saphenous nerve block:
      - provides anesthesia over the medial portion of foot;
      - subcutaneous "field block" with continuous wheal from lateral margin of achilles tendon around the anterior ankle to the medial margin of 
                the achilles tendon will anesthetize all superficial nerves of the foot: superficial peroneal, saphenous, and sural;
      - references:
                - New York School of Regional Anesthesia.  
                - Anesthesia UK. 

- Saphenous Neuritis:
       - Infrapatellar Saphenous Neuralgia – Diagnosis and Treatment
       - Infrapatellar Saphenous Neuralgia After TKA Can Be Improved With Ultrasound-guided Local Treatments.
       - Pulsed radiofrequency neuromodulation for the treatment of saphenous neuralgia
       - Operative management of neuromatous knee pain: patient selection and outcome.

 Study of the infrapatellar nerve
 Arthroscopic meniscal repair with use of the outside-in technique 
 The Surgical Anatomy of the Infrapatellar Branch of the Saphenous Nerve in Relation to Incisions for Anteromedial Knee Surgery  
 The sartorial branch of the saphenous nerve: its anatomy at the joint line of the knee. 

Anatomy of the Hunter's canal and its role in the venous outlet syndrome of the lower limb.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, January 27, 2015 11:16 am

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