Abstract
PurposeInjury to the infrapatellar branch of the saphenous nerve (IBSN) is a relatively common complication after knee surgery, which can interfere with patient satisfaction and functional outcome. In some cases, injury to the IBSN can lead to formation of a painful neuroma. The purpose of this study was to report the results of surgical treatment in a series of patients with IBSN painful neuroma.MethodsWe retrospectively identified 37 patients who underwent resection of IBSN painful neuroma at our institution, after failure of non-operative treatment for a minimum of 6 months. Injury to the IBSN resulted from prior orthopedic surgery, vascular surgery, tumor resection, trauma, or infection. Leg pain and health-related quality of life were measured using the numeric rating scale (NRS) and EuroQol 5 dimensions (EQ-5D) questionnaire, respectively. Clinically meaningful improvement in leg pain was defined as reduction in NRS by at least 3 points. Predictors of favorable and unfavorable surgical outcome were investigated using multivariable logistic regression analysis.ResultsPatient-reported leg pain, health-related quality of life, and overall satisfaction with the surgical outcome were obtained at 94 ± 52.9 months after neuroma surgery. Postoperative patient-reported outcomes were available for 25 patients (68% of the cohort), of whom 20 patients (80.0%) reported improvement in leg pain, 17 patients (68.0%) reported clinically meaningful improvement in leg pain, and 17 patients (68%) reported improvement in health-related quality of life. The average NRS pain score improved from 9.43 ± 1.34 to 5.12 ± 3.33 (p < 0.01) and the average EQ-5D functional score improved from 10.48 ± 2.33 to 7.84 ± 2.19 (p < 0.01). Overall patient reported satisfaction with the surgical outcome was good to excellent for 18 patients (72.0%). Older age, multiple prior orthopedic knee surgeries, and failed prior attempts to resect an IBSN neuroma were associated with non-favorable surgical outcome.ConclusionWe conclude that surgical intervention is efficacious for appropriately selected patients suffering from IBSN painful neuroma.
Highlights
The infrapatellar branch of the saphenous nerve (IBSN) is a small nerve that originates at the medial aspect of the knee and provides sensation to the area of the tibial tuberosity without a motor component [1, 2]
Surgical approaches to the anteromedial knee may be complicated by iatrogenic injury to the IBSN, which has been reported after total knee arthroplasty (TKA), arthroscopic knee surgery, anterior cruciate ligament reconstruction, and surgical meniscectomy [3,4,5,6,7,8,9,10]
Symptomatic IBSN injury has been reported in 55–100% of patients following TKA when a longitudinal incision is used, in 37–86% of patients following anterior cruciate ligament (ACL) reconstruction, and in up to 28% of patients following surgical meniscectomy [4, 5, 9]
Summary
The infrapatellar branch of the saphenous nerve (IBSN) is a small nerve that originates at the medial aspect of the knee and provides sensation to the area of the tibial tuberosity without a motor component [1, 2]. Surgical approaches to the anteromedial knee may be complicated by iatrogenic injury to the IBSN, which has been reported after total knee arthroplasty (TKA), arthroscopic knee surgery, anterior cruciate ligament reconstruction, and surgical meniscectomy [3,4,5,6,7,8,9,10]. Symptomatic IBSN injury has been reported in 55–100% of patients following TKA when a longitudinal incision is used, in 37–86% of patients following anterior cruciate ligament (ACL) reconstruction, and in up to 28% of patients following surgical meniscectomy [4, 5, 9]
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