Validation of a Novel Landmark-guided Intra-articular Postero-medial Surgeon-administered Injection Technique

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Anatomy

Background:

• Developing effective pain management strategies for knee procedures is crucial.
• Ultrasound-guided adductor canal block (US-guided ACB) is a common technique.
• An intra-articular surgeon-administered technique comparable to US-guided ACB is needed.

Purpose of the Study:

• To define a surgeon-administered intra-articular technique for knee analgesia.
• To assess its comparability to US-guided adductor canal block (ACB).

Main Methods:

• Five cadaver lower limbs were utilized.
• An orthopedic surgeon performed a medial parapatellar arthrotomy.
• A needle was introduced proximal to the adductor tubercle, and dye spread was documented fluoroscopically.

Main Results:

• The surgeon-administered technique successfully reached key nerves including the infrapatellar branch of the saphenous nerve and the nerve to the vastus medialis muscle.
• The posterior capsule was consistently targeted.
• Minimal dye spread proximally was observed.

Conclusions:

• This intra-articular technique can effectively target relevant anatomical structures for knee analgesia.
• It may serve as an efficient complement to existing adductor canal block (ACB) or surgeon infiltration methods.
• The technique presents a viable alternative to US-guided ACB when ultrasound guidance is unavailable.