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Objective <p>This randomized controlled trial conducted a comparative analysis of postoperative outcomes between a modified anteromedial incision with saphenous nerve protection and the traditional medial parapatellar approach in total knee arthroplasty (TKA). We aimed to test the hypothesis that the nerve-sparing modified technique would significantly reduce postoperative anterior knee numbness and pain while maintaining surgical feasibility.</p> Methods <p>Sixty-eight TKA candidates (January 2022-June 2023) were prospectively randomized into two groups: Modified (<i>n</i> = 34) and Traditional (<i>n</i> = 34) approaches. The modified technique featured an anteromedial incision with infrapatellar branch visualization and preservation, whereas the control group received the traditional medial parapatellar exposure. Primary outcomes included numbness area and the Visual Analog Scale score; secondary outcomes encompassed surgical parameters (duration, blood loss) and functional recovery (Hospital for Special Surgery Knee score).</p> Results <p>Thirty one patients were randomized to the M group and 29 patients allocated to the T group. Compared to the T group, the M group demonstrated significantly lower VAS scores at 3 days, 7 days, and 2 weeks postoperatively, with statistical significance (<i>P</i> &lt; 0.05). The M group showed a statistically significant reduction in the area of numbness compared to the T group at all postoperative follow-up intervals: 2 weeks, 1 month, 3 months, 6 months, and 1 year (<i>P</i> &lt; 0.05 for all time points). However, postoperative HSS scores did not differ significantly between the M group and the T group at any follow-up interval (<i>P</i> &gt; 0.05).</p> Conclusion <p>The nerve-preserving modified approach achieved superior patient-reported outcomes (PROs) in reducing anterior knee numbness and early postoperative pain without compromising prosthesis implantation accuracy or functional recovery trajectories, suggesting its potential as a standardized refinement in TKA surgical protocols.</p> Trial registration <p>Chinese Clinical Trial Registry, ChiCTR2500107220, 6 August 2025, retrospectively registered.</p>

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Application of saphenous nerve infrapatellar branch protection technique in total knee arthroplasty

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月14日

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  • Zhi-Qiang Mao,
  • Kai Li,
  • Zhou Zhang,
  • Ting Li,
  • Jian-hua Lu,
  • Meng-Qiang Fan,
  • Xiao-bing Chu

摘要

Objective

This randomized controlled trial conducted a comparative analysis of postoperative outcomes between a modified anteromedial incision with saphenous nerve protection and the traditional medial parapatellar approach in total knee arthroplasty (TKA). We aimed to test the hypothesis that the nerve-sparing modified technique would significantly reduce postoperative anterior knee numbness and pain while maintaining surgical feasibility.

Methods

Sixty-eight TKA candidates (January 2022-June 2023) were prospectively randomized into two groups: Modified (n = 34) and Traditional (n = 34) approaches. The modified technique featured an anteromedial incision with infrapatellar branch visualization and preservation, whereas the control group received the traditional medial parapatellar exposure. Primary outcomes included numbness area and the Visual Analog Scale score; secondary outcomes encompassed surgical parameters (duration, blood loss) and functional recovery (Hospital for Special Surgery Knee score).

Results

Thirty one patients were randomized to the M group and 29 patients allocated to the T group. Compared to the T group, the M group demonstrated significantly lower VAS scores at 3 days, 7 days, and 2 weeks postoperatively, with statistical significance (P < 0.05). The M group showed a statistically significant reduction in the area of numbness compared to the T group at all postoperative follow-up intervals: 2 weeks, 1 month, 3 months, 6 months, and 1 year (P < 0.05 for all time points). However, postoperative HSS scores did not differ significantly between the M group and the T group at any follow-up interval (P > 0.05).

Conclusion

The nerve-preserving modified approach achieved superior patient-reported outcomes (PROs) in reducing anterior knee numbness and early postoperative pain without compromising prosthesis implantation accuracy or functional recovery trajectories, suggesting its potential as a standardized refinement in TKA surgical protocols.

Trial registration

Chinese Clinical Trial Registry, ChiCTR2500107220, 6 August 2025, retrospectively registered.