The combined treatment of entrapped Infrapatellar Branch of the Saphenous Nerve after ACL reconstruction: Ultrasound-guided perineural injection and acupotomy
Affiliations: [a] Department of Rehabilitation, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China | [b] Queen Mary School, Nanchang University, Nanchang, Jiangxi, China | [c] Department of Sports Medicine, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China | [d] Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
Correspondence:
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Corresponding authors: Hongshi Huang, Department of Sports Medicine, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing 100191, China. Tel.: +86 10 62835149; E-mail: huanghs @bjmu.edu.cn. Xiangzuo Xiao, Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China. E-mail: xxz8785@sina.com.
Note: [1] Yi Rao and Fangxing Hou contributed equally to this study.
Abstract: BACKGROUND: The anterior cruciate ligament (ACL) reconstruction (ACLR) under the arthroscopy is a widespread procedure for ACL rupture, which could stabilize knee and promote recovery. However, one of its complications is the injury of infrapatellar branch of saphenous nerve (IBSN). In traditional Chinese medicine, acupotomy functions via releasing and stripping adhesion tissues. Accordingly, acupotomy is suitable for the treatment of entrapped nerve injury and tissues adhesion. CASE DESCRIPTION: A 14-year-old man, who had ACLR before and returned to normal activity, presented with severe pain after a mild strain two weeks ago. The physical and imaging examinations revealed the compression injury of IBSN. METHODS: We provided the ultrasound-guided perineural injection of 0.4% lidocaine, while it only alleviates the symptoms temporally and partially. Acupotomy using a small needle knife (0.4*40 mm) was performed. RESULTS: The severe pain was immediately resolved. The visual analog pain scale (VAS) decreased from 10 to 1 and return to normal walking. The diameter of IBSN became smaller and the signal of peripheral soft tissue became hypoechoic in ultrasound. CONCLUSION: In this case, the combined treatments of ultrasound-guided perineural injection and acupotomy are thought to be innovative procedures for IBSN entrapment with relative long-lasting therapeutic effects.
