Entrapment of the saphenous nerve is probably under-recognized and presents with numbness/pain in the infrapatellar region and the medial aspect of the lower leg. The vastoadductor intermuscular septum is responsible for entrapment symptoms as it forms the anterior fascia of the adductor canal, deep to the sartorius muscle. The femoral vessels and saphenous nerve have a course within this canal and the nerve may anteriorly pierce through the intermuscular septum. Decompression of the saphenous nerve involves the release of the vastoadductor intermuscular septum. In this case, the patient presented with severe pain in the lower extremity and diagnosed with complex regional pain syndrome. Her neuropathic pain began seven-years-ago following a revision knee operation for knee stiffness. The patient described the regions of neuropathic pain on the lateral aspect of the foot, lateral aspect of the lower leg, and medial aspect of the thigh. Provocative tests, specifically the scratch collapse test with ethyl chloride, identified provocation in the following order: superficial peroneal nerve, common peroneal nerve, and saphenous nerve. Release of the superficial peroneal nerve, common peroneal nerve, and saphenous nerve were elected. This video details the specifics for the saphenous nerve release.
Standard:
Extended:
POSITION
Supine.
INCISION
An incision is made along the medial aspect of the thigh between the vastus medius and adductor muscles to expose the adductor canal.
REFERENCES
- Morganti CM, McFarland EG, Cosgarea AJ. Saphenous neuritis: a poorly understood cause of medial knee pain. J Am Acad Orthop Surg. 2002 Mar-Apr;10(2):130-7. Review. PMID: 11929207.
- Romanoff ME, Cory PC Jr, Kalenak A, Keyser GC, Marshall WK. Saphenous nerve entrapment at the adductor canal. Am J Sports Med. 1989 Jul-Aug;17(4):478-81. PMID: 2782531.
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.
Excellent video of a saphenous nerve decompression. I have removed a saphenous schwannoma at the origin of the adductor canal through a more more anterior route (anterior border of sartorius) but your ‘medial’ approach looks easier. I agree that saphenous nerve decompressions are not for the faint hearted especially in patients with a high BMI!
Could you upload a video on iliohypogastric and genitofemoral decompressions, especially the easiest way of finding the genitofemoral nerve, please? Many thanks.
I Low
Thanks I Low, we have a paper that is currently is currently in the works describing the approach and outcomes with an older video. I will be sure to keep a look out for this procedure to produce.
This is a great video and demonstration.Thank you. I know you describe it briefly in both videos, but could you please go into more detail about what symptoms patients typically present with when they have a compressed saphenous nerve? What kind of knee pain do patients describe? Is there always associated tenderness in the quad or do some patients only present with knee pain? Thank you so much!
Thanks for the comments. We’re working on video modules within the clinical judgment section to help subject. A
Thank you for the reply. Looking forward to it.
Regards,
Sam