Abstract
A small portion of patients suffer from severe knee pain following previous knee surgery or a trauma. Awareness among traumatologists regarding a neuropathic origin of this persistent knee pain is poor. Ongoing pain close to the knee may be caused by damage of the infrapatellar nerve (IN). This branch of the saphenous nerve is purely sensory and is at risk for iatrogenic damage due to its superficial medial course. Once recognized using simple tests during physical examination, a variety of treatment modalities may be proposed. However, a standard treatment algorithm was hitherto absent. This study includes 15 patients having IN damage who were offered a step-up regimen including lidocaine injections, pulsed radiofrequency (PRF) or neurectomy. Success (>50% drop in numeric rating scale pain score) was attained in 11 (73% success rate, 9 month median follow-up). The aim of this contribution is to increase knowledge regarding this illusive entity and to discuss the efficacy of our treatment protocol.
Zusammenfassung
Nach einer Knieoperation oder einem Trauma leidet eine kleine Gruppe von Patienten unter starken andauernden Knieschmerzen. Traumatologen denken in solchen Fällen selten an einen neuropathischen Ursprung derselben. Chronische Schmerzen in Knienähe können durch eine Schädigung des R. infrapatellaris verursacht werden. Dieser Endast des N. saphenus ist rein sensorisch und aufgrund seines oberflächlichen medialen Verlaufs einem hohen Risiko gegenüber iatrogenen Schädigungen ausgesetzt. Einmal mittels einfacher Tests während der körperlichen Untersuchung erkannt, können verschiedene Behandlungsmethoden vorgeschlagen werden. Jedoch fehlte bisher ein standardisierter Therapiealgorithmus. Diese Studie umfasst 15 Patienten mit einer Schädigung des R. infrapatellaris, denen ein an Intensität zunehmendes Therapieregime – Lidocaininjektionen, gepulste Radiofrequenztherapie (PRF) oder Neurektomie – angeboten wurde. Ein Behandlungserfolg (> 50 % Rückgang in der numerischen Schmerzbewertungsskala) wurde in 11 Patienten erreicht (73 %ige Erfolgsrate, Nachbeobachtungszeit im Median 9 Monate). Ziel dieses Beitrags ist, das Wissen über diese Entität zu erweitern und die Wirksamkeit unseres Behandlungsprotokolls zu diskutieren.
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W. van Dijk, P. van Eerten and M. Scheltinga declare that they have no competing interests.
For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.
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M. Scheltinga, Veldhoven, NL
P. van Eerten, Veldhoven, NL
The German version of this article can be found under https://doi.org/10.1007/s00113-019-00721-5.
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van Dijk, W., van Eerten, P. & Scheltinga, M. Infrapatellar nerve damage. Unfallchirurg 123 (Suppl 1), 25–28 (2020). https://doi.org/10.1007/s00113-019-0688-7
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DOI: https://doi.org/10.1007/s00113-019-0688-7