Abstract
The infrapatellar branch of the saphenous is becoming a common therapeutic target for the diagnosis and treatment of anterior knee pain. It is a nerve commonly injured during knee surgeries, resulting in neuroma formation and chronic neuropathic pain states, and can also transmit nociceptive input in patients with non-surgical anterior knee pain of multiple etiologies. After diagnosing infrapatellar saphenous neuralgia, the nerve is safely ablated using radiofrequency ablation, neurolytic solutions, and, most recently, cryoablation using the handheld iovera® cryoablation system (Myoscience, Inc. Fremont, CA). The iovera® technology benefits from procedural simplicity in that the nerve doesn’t specifically need to be identified and the described technique involves treating a long line over which the infrapatellar branch of the saphenous nerve is expected to course. However, there is significant variability in the course of the nerve and much of the area treated misses the actual location of the nerve, wasting time and potentially increasing patient discomfort and risk of complications. To address these limitations we endeavored to identify a way to more precisely treat the specific location of the nerve thereby optimizing treatment success and procedural simplicity. Using a MiniStim® peripheral nerve stimulator (Halyard Health, Inc., Georgia, US) to scan for the nerve along the previously described treatment line, we have been able to identify a more precise location of the nerve and optimize the treatment target area. This non-invasive identification technique has, to our knowledge, not been previously described.
Highlights
Chronic non-surgical anterior knee pain is a common condition and a major source of disability, with limited long-term treatment options after a patient has failed physical therapy [1,2]
In the patients that we manage with chronic non-surgical anterior knee pain who have failed physical therapy and the other conservative modalities of pain management listed above, we consider palliative neuroablative techniques
This procedure has been demonstrated to be effective in patients with symptoms of knee arthritis [4], and we find it effective for patients with chronic non-specific anterior knee pain
Summary
Chronic non-surgical anterior knee pain is a common condition and a major source of disability, with limited long-term treatment options after a patient has failed physical therapy [1,2]. The purpose of this recommendation is to simplify the procedure and encompass the variable course of the infrapatellar branch of the saphenous nerve. The device has a surface probe attachment, which allows scanning over the skin and has a 50 Hz tetanus setting as well as an intensity control knob This allows for stimulation at an acceptable threshold for the awake patient to sense nerve stimulation as a comfortable buzzing sensation while avoiding unnecessary discomfort or invasive needles for stimulation. White Stars: Original iovera® recommended treatment line; White Arrow: Peripheral nerve stimulator identified treatment line
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call