Abstract
BackgroundNeuritis of the infrapatellar branch of the saphenous nerve can result from iatrogenic injury, entrapment, bursitis, or patellar dislocation. Currently, there is an unmet clinical need for treating refractory neuritis nonsurgically.Case presentationThree patients presented with persistent anterior knee pain caused by neuritis of the infrapatellar branch of the saphenous nerve that had got excellent but only temporary relief from steroid and local anesthetic nerve block. The neuropathic pain diagnostic Douleur Neuropathique 4 questionnaire and painDETECT questionnaire confirmed presence of neuropathic pain. After injection with 25 mg amniotic and umbilical cord particulate, the patient’s pain decreased from 7.3 before injection to 0.3 at 6 weeks postinjection. In addition, neuropathic symptoms significantly improved at 2 weeks and were not present by 6 weeks. By 63 weeks, two of the patients reported continued complete pain relief, while one patient underwent total knee replacement due to an allergy of a previously implanted unicondylar implant.ConclusionsThis case series suggests that amniotic and umbilical cord particulate may be a viable alternative to reduce pain in patients with neuropathic pain.
Highlights
The saphenous nerve is a sensory nerve that provides innervation from the medial thigh to the medial knee and great toe
Incidence rates have been published as high as 22.2–65.7% of patients undergoing general arthroscopic knee surgery or anterior cruciate ligament (ACL) reconstruction, usually due to vertical skin incisions made perpendicular to the nerve anatomy [7,8,9,10,11,12]
To assess for potential infrapatellar saphenous neuralgia, a diagnostic infrapatellar branch of the saphenous nerve (IPS) block with 2 mL Marcaine 0.25% plain and 0.5 mL of Depo-Medrol 40 was injected along the region of maximum pain, which was at the medial inferior portion of the knee
Summary
This case series suggests that amniotic and umbilical cord particulate may be a viable alternative to reduce pain in patients with neuropathic pain.
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