Summary
Prospective study about operative treatment of Saphenous nerve syndrome after ACL reconstruction.
Abstract
Introduction
Damage and irritation of the inferior branch of the Saphenous nerve is an often overseen and neglected complication after knee surgery especially after ACL reconstruction.
In ACL reconstruction there is a high risk of harming the Sapheneous nerv at two locations.
The locations of the nerve branches are quite variable. With high probability the inferior branch of the Saphenous nerve can be compromised through the deep medial arthroscopic portal and more likely through the tibial approach for tibial tunnel drilling and harvesting of hamstrings in the area of the superficial pes anserinus.
Goal of the study was to follow patients after neurolysis or neuromectomy and show pain relief results up to 6 months after intervention.
Material And Methods
In this study we prospectively followed 30 patients with Saphenous nerve irritation and/or neuroma suffering from typical extraarticular medial pain syndrome which have been operated.
21 patients presented pain syndrome following ACL reconstruction, 5 after arthroscopy and meniscus surgery 2 after HTO and 2 after medial partial knee replacement.
The diagnosis has been confirmed by typical neuropathic pain at the scar area with pain triggering during local anesthetic injection following complete pain relief.
In some cases just neurolysis and most cases neuromectomy with coagulation of the nerve have been done.
Visual analog scale pain before operation and 2 weeks, 3 months and 6 months after intervention have been investigated.
The area of paresthesia before and after intervention has been analyzed and documented.
All Patients have been asked about satisfaction.
Results
Praeoperatively a mean VAS of 4.83 has been detected. Operative intervention could reduce the pain scale VAS significantly to 1.1 two weeks after operation, 1.4 three months and 1.7 six months after operation. The area of paresthesia increased 3 times in comparison to praeoperative situation.
The patients satisfaction was very high: 28 of 30 patient are satisfied with intervention result.
Discussion
The Saphenus nerve pain syndrome is an often-overseen complication.
The study results show that operative intervention can successfully treat this pain syndrome.
The most important part of treatment is the awareness of surgeons to diagnose the pain reason.