Patellar denervation for Anterior Knee Pain Management in Knee Arthroplasty

Abstract

OBJECTIVE:To compare the effectiveness of patellar denervation versus non-patellar denervation in reducing anterior knee pain on a follow-up period of at least one year after total knee arthroplasty. METHOD: Data from 84 patients, who underwent total knee arthroplasty were analyzed. Participants were divided into 2 groups; group A: 42 patients who previously underwent total knee arthroplasty with patellar denervation; and group B: 42 patients who previously underwent total knee arthroplasty without patellar denervation. Results were evaluated using WOMAC and KSS questionnaires, and the VAS pain measurement. Knee ranges of motion were measured. Preoperative clinical conditions of both groups were similar. RESULTS: Postoperatively, the following results were observed. (a), the WOMAC scores for group A were significant better when compared to group B (27.95 ± 5.89 vs. 33,55 ± 6.23; (b) better results were also found in KSS scores for group A vs. group B (86.19 ± 7.10 vs. 83,07 ± 4.88); (c) the range of knee flexion was smaller than in group A vs. group B (119.0 ± 10.7 vs 125.5 ± 11.0 degrees); (d) there was no significant difference between the mean of range of knee extension between the two groups groups; (e) in terms pain referred by the patient, no difference was observed according to VAS pain. CONCLUSION: Patellar denervation does not show better effect in pain reduction compared with TKA with non-patellar denervation. However, it had a better beneficial effect on knee function score, as measured through the KSS and WOMAC questionnaires. This procedure has become quite common, especially in the last two decades due to the aging of population and to the growing number of obese people. 2,3One of the most common problems during the postoperative period of this procedure is the incidence of anterior knee pain (AKP). About 10 to 15% of patients undergoing surgery will show these symptoms. It is noteworthy that the presence of pain is of utmost importance when evaluating the results of TKA, because patient satisfaction is linked to its presence or absence during the postoperative period. 4,5 Some authors assign the AKP to the distribution of nerve fibers and P-substance in soft tissues around the knee, suggesting a relation with hyper-innervation of peripatellar soft tissues. Therefore, disabling these nerve fibers by electrocautery could, in theory, achieve a satisfactory level of denervation and, consequently, reduce local pain. 1,6 Studies have shown a positive effect of patellar denervation in reducing the incidence of AKP. 7,8 A recent meta-analysis demonstrated that patellar denervation

Customized footwear for motion control to treat anterior knee pain among runners

“…This study is part of our general project on AKP. 19 A limitation of our study was the small sample size, which did not allow for the performance of multivariate analyzes to certify the weight of each variable in the event of injury. Randomized control trials should be performed, comparing each foot orthosis and cushioning, as well as the instruments to evaluate the lower limb posture and gait.…”