Management of Chronic Knee Pain Caused by Postsurgical or Post-traumatic Neuroma of the Infrapatellar Branch of the Saphenous Nerve.

Purpose: Injury to the infrapatellar branch of the saphenous nerve (IBSN) is a relatively common complication after knee surgery that can interfere with patient satisfaction and functional outcome. In some cases, trauma to this nerve can lead to the formation of a painful neuroma. The purpose of this study is to report the results of surgical treatment in a series of patients with IBSN painful neuroma.Methods: A retrospective review was made of 37 patients undergoing resection of IBSN neuroma at our institution, after failure of non-operative treatment for a minimum of 6 months.Results: Following surgery, 80% of the patients experienced statistically and clinically significant improvement in pain levels. The average NRS Pain score improved from 9.43±1.34 to 5.12±3.33 (p<0.001). The EQ-5D functional score improved from 10.48±2.33 to 7.84±2.19. Overall patient reported satisfaction from the surgical results was good to excellent in 72% of patients. Non-favorable prognosis was found to correlate with older age, multiple prior orthopedic surgeries at the knee area and failed prior attempts to resect an IBSN neuroma. Conclusion: We conclude that in patients suffering from IBSN painful neuroma, surgical resection results in a favorable prognosis.

A CASE OF TRAUMATIC NEUROMA OF THE COMMON BILIARY DUCT SIMULATING A CHOLANGIOCARCINOMA

We present a case of traumatic neuroma of the common bile duct in a 53-year-old woman who presented with jaundice,5months after cholecystectomy. Physical examination revealed jaundice, epigastric pain and scratching lesions. Gamma glutamyl transferase (GGT) at 109 U/L, Alkaline phosphatase at 175U/L. CA19-9 was at 500U/mlMagnetic resonance cholangiopancreatography revealed a T1 and T2hyperintense lesion of peri-hilar fat. An increase in intensity was noted after useof gadolinium.Exploratory laparotomy was performed with the presumptive diagnosis of cholangiocarcinoma. Pathologic analysis of the surgical specimen revealed Haphazard mature nerves, consistent with a bile duct neuroma. Follow-up of the patient showed no post-operative complications or signs of recurrence.