Pain Medicine Journal reposted this
Anatomist, Researcher, and Tech Entrepreneur | Let's talk about anatomical data-driven optimization of clinical procedures
To my colleagues interested in knee RFA: it has been six years since my team published our well-received anatomical study on the innervation of the #knee joint. At that time, there was great excitement and expectation, as the knowledge from that study provided a foundation for the precise targeting of nerves to improve the image guided procedures to treat #chronic knee #pain due to #osteoarthritis. Since then, there has been a general trend in the right direction where there is greater awareness that the extensive innervation pattern requires more lesions. However, one of the controversial topic is the proposed targeting of the infrapatellar branch of the saphenous nerve (IPBSN). Described mainly as a cutaneous nerve, the proposed targeting of this nerve to treat osteoarthritic pain is peculiar, especially when there are other more consistent targets. Furthermore, its course within the subcutaneous tissue makes denervation without causing third-degree skin burns challenging—a complication that has been reported. So, the question is: should we target the IPBSN to treat patients with knee osteoarthritic joint pain? Check out our team’s most recent anatomy study on the relationship between the IPBSN and the inferior medial genicular nerve (IMGN) below. The accepted manuscript version is published in Pain Medicine Journal . The lead author, Ms. Paula Yu meticulously documented the 3D course and relationship between the two nerves, reporting very insightful and clinically important findings. ⬇ https://lnkd.in/gnbn6xuB Key Findings: 📌 IPBSN was found to be cutaneous (no articular branches!) and its course was variable. 📌Course of anterior branches of the IMGN was consistent and overlapped with IPBSN. 📌Previously proposed strip lesion would consistently capture the IMGN but not IPBSN (depending on variation). Significance: The implication of this study is that the proposed strip lesion may mediate its pain relief by denervating the IMGN at a more anterior position. Since the IPBSN was found to be cutaneous, denervating this nerve to treat chronic knee pain due to osteoarthritis may be unnecessary. Final Thoughts: While #anatomy #research is time- and labor-intensive, it is the current gold standard for optimizing #interventionalpainmedicine techniques. Although this type of research is hard to conduct, to guide our clinical focus in the right direction it often requires us to tackle difficult tasks. That’s why continued investment in high-quality anatomical research is needed. Anatomy research will continue to make important clinical impacts in 2024 and beyond. Research Team: Paula J. Y., Eldon Loh, Anne Agur, John Tran Temerty Faculty of Medicine, University of Toronto University of Toronto St. Joseph's Health Care London Western University