Korean J Pain.  2023 Jul;36(3):328-334. 10.3344/kjp.23112.

Investigation of the existence of and a block technique for the inferior lateral genicular nerve: cadaveric study

• Kim J
• Kim JY
• Shin HY
• Sim SE
• Chung S
• Jeon Y
• Kim SH
• Jeong JM
• Kim J
• Lee UY
• Park HJ

• KMID: 2544244
• DOI: http://doi.org/10.3344/kjp.23112

Abstract

Background
Among the four genicular nerves innervating the anterior aspect of the knee, the inferior lateral genicular nerve has been omitted as a target of blocking. Some authors have suggested that the inferior lateral genicular nerve of the knee might pass beneath the lateral collateral ligament of knee. The authors aimed to study the location of the inferior lateral genicular nerve and the spread of injectate during the inferior lateral genicular nerve block.
Methods
In ten knees from fresh frozen cadavers, the authors performed on each an ultrasound-guided block of the inferior lateral genicular nerve of the knee just below the lateral collateral ligament. The needle was inserted below the lateral collateral ligament, and 2 mL of blue dye was injected. A week later, the cadavers were dissected, and the existence of the inferior lateral genicular nerve and the spread of dye around it was investigated.
Results
The proportion of inferior lateral genicular nerves branching from the common peroneal nerve was found in 8 of 10 (80.0%) cadavers. Of these eight cadavers with inferior lateral genicular nerve, five specimens (62.5%) were stained with blue dye. The common peroneal nerve was not infiltrated with dye in any specimens.
Conclusions
When 2 mL of dye was inserted inferiorly to the lateral collateral ligament, the inferior lateral genicular nerve could be blocked in 62.5% of specimens. Because the common peroneal nerve was not involved in any specimen, motor weakness would be avoided with this method.

Keyword

Cadaver; Genicular Nerve; Knee Joint; Nerve Block; Osteoarthritis, Knee; Pain Management; Peroneal Nerve; Ultrasonography, Interventional

Figure

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  Fig. 1 Needle placement during inferior lateral genicular nerve block.

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  Fig. 2 Ultrasound-guided block of inferior lateral genicular nerve. The white straight structure is the block needle. Double asterisks indicate the injected material. LCL: lateral collateral ligament.

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  Fig. 3 Inferior lateral genicular nerve (ILGN) branching to the lower part of the lateral epicondyle of femur. Asterisks indicate the lateral epicondyle. The hollow arrowhead indicates the main branch of the common peroneal nerve, and the black arrowhead indicates the ILGN. Blue dye has reached the ILGN in this specimen.

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  Fig. 4 Cadaveric dissection of inferior lateral genicular nerve (ILGN) and superior lateral genicular nerve (SLGN). (A) Presence of the SLGN and ILGN in the authors’ specimen. Blue dye is not reaching either nerve in this specimen. The white arrowhead indicates the SLGN, and the black arrowhead indicates the ILGN. (B) In this specimen, blue dye is infiltrating the ILGN while sparing the SLGN. Forceps is pinching the common peroneal nerve for better visualization. The white arrowhead indicates the SLGN, and the black arrowhead indicates the ILGN.

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  Fig. 5 Intraarticular injection in one knee. Blue dye material confirms the presence of blue dye material.

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