09/04/2025
📃Management of chronic knee pain caused by postsurgical or posttraumatic neuroma of the infrapatellar branch of the saphenous nerve
📌 Key Takeaways
-Injury 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.
-Symptomatic IBSN injury has been reported in 55–100% of patients following Total Knee Arthroplasty (TKA) , in 37–86% following ACL reconstruction, and in up to 28% following surgical meniscectomy.
-Injury to the IBSN may also result in neuroma formation due to Wallerian degeneration and subsequent axonal growth, leading to severe and debilitating pain.
-Following surgery, 80.0% reported improvement in leg pain, 68.0% reported clinically meaningful improvement, and 68.0% reported improvement in health-related quality of life.
-Overall, 72.0% reported they were satisfied with the surgical outcome.
-Lack of postoperative improvement was significantly associated with older age, female gender, multiple prior knee surgeries, and prior resection of IBSN neuroma.
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🩺 Clinical Implications
-Neuroma of the IBSN should be suspected in patients who develop neuropathic medial knee pain following orthopedic surgery or trauma.
-IBSN neuroma as a cause of debilitating chronic knee pain is likely under-recognized, particularly in community hospitals and other institutions without a dedicated peripheral nerve surgery unit.
-In properly diagnosed and selected patients, surgical neurolysis and resection of painful IBSN neuroma provide clinically meaningful pain improvement in a majority of patients as well as improvement in health-related quality of life.
-Future research should verify risk factors for poor postsurgical outcome and optimize selection criteria for surgical intervention.
👉Link to article in the comments 👇
📌Whay about physiotherapy?(out of the article)
🏥 Role of Physical Therapy in IBSN Neuroma Management
🔹 Before Surgery (Conservative Phase)
-Pain modulation:
Desensitization techniques (gentle massage, tapping, graded exposure to textures).
-TENS or other neuromodulation methods for neuropathic pain relief.
-Edema and scar management:
Soft tissue mobilization, scar massage, silicone pads if surgical scar sensitivity is present.
-Activity modification:
Avoiding positions or activities that overstretch or compress the nerve.
-Functional maintenance:
Gentle quadriceps strengthening, ROM exercises, avoiding aggravation of neuropathic symptoms.
🔹 After Surgery (Post-Neuroma Resection / Neurolysis)
-Wound care & protection: Early phase focus on healing, avoiding excessive stretch on the medial knee.
-Gradual desensitization: Continued sensory re-education to reduce hypersensitivity.
-Strength & mobility: Restore knee ROM, quadriceps and hip strength, and gait training.
-Neuropathic pain management: TENS, graded motor imagery, mirror therapy if central sensitization develops.
-Functional rehab: Progression to ADL training, balance work, and gradual return to activity.
⚠️ Key Considerations for PT
👉If neuroma pain is severe and refractory → physiotherapy alone is usually insufficient, and surgery may be required.
👉PT is most beneficial for symptom modulation, function maintenance, and postoperative rehabilitation.
👉Collaboration with pain specialists and orthopedic/nerve surgeons is crucial for comprehensive management.
