The infrapatellar branch of the saphenous nerve arises from the saphenous nerve in the adductor canal or just below it and passes through the sartorius muscle to emerge medially below the patella, supplying the skin of the inferomedial knee and the patellar ligament region. It is frequently injured during knee surgery, producing numbness or neuroma in the medial infrapatellar area.
The infrapatellar branch is the most commonly injured nerve in knee surgery, injured in virtually all medial parapatellar knee arthrotomies, ACL reconstruction incisions, and knee arthroplasty approaches. The resulting lateral leg paraesthesia and medial knee numbness is expected but should be discussed pre-operatively. When a painful neuroma forms at the incision site, it can be managed by steroid injection or by surgical excision with proximal nerve translocation. The nerve's course through sartorius makes it vulnerable to traction injury during limb alignment correction.
Medial parapatellar incisions for knee arthroplasty and tibial tunnel incisions for ACL reconstruction commonly injure the infrapatellar branch of the saphenous nerve, producing a painful neuroma at the incision site with Tinel sign and radiating paraesthesia, treated by corticosteroid injection and in persistent cases by excision with nerve end relocation.
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