Adductor Canal Block for Knee Osteoarthritis
Image 1. Normal knee (left) and knee arthritis (right). Note the joint space narrowing, subchondral sclerosis and osteophyte formation on the right image.[5]Image courtesy of orthobullets, https://www.orthobullets.com/recon/12287/knee-osteoarthritis
Image 2. Anatomy of the adductor canal (click to enlarge)[6]Image courtesy of https://anatomyqa.com/, “adductor canal”
Studies
Summary
In summary, these three studies provide some compelling evidence that the ACB may be a useful tool in the management of knee OA. Identifying which patients will benefit most, likely patients with medial knee OA based on the anatomy of the saphenous nerve, needs to be clarified. Further, where the ACB fits in the treatment algorithm and how it truly compares head-to-head with other non-surgical options requires further research. The optimal injectate for long lasting relief also requires clarification.
References[+]
↑1 | Hunter D.J., Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393:1745–1759. doi: 10.1016/S0140-6736(19)30417-9. |
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↑2 | Zhang Y., Jordan J.M. Epidemiology of Osteoarthritis. Clin. Geriatr. Med. 2010;26:355–369. |
↑3 | GBD 2015 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545–1602. |
↑4 | Prince M.J., Wu F., Guo Y., Gutierrez Robledo L.M., O’Donnell M., Sullivan R., Yusuf S. The burden of disease in older people and implications for health policy and practice. Lancet. 2015;385:549–562. |
↑5 | Image courtesy of orthobullets, https://www.orthobullets.com/recon/12287/knee-osteoarthritis |
↑6 | Image courtesy of https://anatomyqa.com/, “adductor canal” |
↑7, ↑11 | Ming, Lee Hwee, et al. “Adductor canal block versus intra-articular steroid and lidocaine injection for knee osteoarthritis: a randomized controlled study.” The Korean Journal of Pain 35.2 (2022): 191-201. |
↑8 | Lee, Doo-Hyung, et al. “Effect of adductor canal block on medial compartment knee pain in patients with knee osteoarthritis: Retrospective comparative study.” Medicine 96.12 (2017). |
↑9 | Fusco, Pierfrancesco, et al. “‘Inverse Double Bubble’sign for an effective adductor canal block: a novel approach for the ultrasound confirmation of being on the right site.” Regional Anesthesia and Pain Medicine 44.4 (2019): 527-528. |
↑10 | Salihovic, Mensur, et al. “Effectiveness of Ultrasound-Guided Canal Adductor Blockade for Chronic Pain and Functioning in Knee Osteoarthritis: A Prospective Longitudinal Observational Study.” BioMed Research International 2022 (2022). |