Management of chronic leg and knee pain following surgery or trauma related to saphenous nerve and knee neuromata

Abstract

Patients who present with lower extremity pain following surgery or trauma can occasionally have the saphenous nerve as the offending anatomic cause of their pain. Consistent with its anatomic course, the saphenous nerve can be the source of pain that manifests anywhere along its sensory distribution.Patients who presented to the Georgetown Peripheral Nerve Institute with lower extremity pain were evaluated, and those patients whose pain was suspected to be of saphenous nerve origin were offered surgical treatment. The surgical intervention included excision of the neuroma and/or nerve decompression, as clinically indicated. Patients were followed clinically and evaluated for both their pain as well as recovery in their ambulation and quality of life.Forty-two consecutive patients underwent surgery for pain of saphenous nerve origin from 2003 to 2008; 69% of these patients had concomitant surgery on another involved lower extremity peripheral nerve. Follow-up was achieved in 35 patients (83% response rate), with an average follow-up duration of 34.7 months. Using a 10-point pain scale, patients reported their preoperative pain as an 8.0 and their postoperative pain as a 2.37 (P < 0.001). Of the 35 patients, 30 (86%) were able to ambulate at the last follow-up encounter. Patients were asked to report their quality of life on a 10-point scale, and reported a 77% recovery of their baseline quality of life as a result of peripheral nerve surgery performed. Of the 35 patients, 29 reported that the surgery effectively resolved their pain, yielding a success rate of 82.8%.The saphenous nerve can be a source of lower extremity and knee pain following trauma or surgery. Accurate clinical diagnosis followed by surgical intervention can result in clinical resolution in the majority of patients, with improvement in ambulation and quality of life. This study reports the largest series of surgically-corrected saphenous neuropathy in the literature.