| 제목 |
Atypical symptom of the saphenous neuropathy after ACL reconstruction: A case report |
| 소속 |
The Catholic University of Korea Bucheon St. Mary`s hospital, Department of Rehabilitation Medicine1 |
| 저자 |
Moa Jung1*, Cheolki Kim1, Sun Im1, Sunha Park1, Guen-Young Park1† |
[Introduction]
The infrapatellar branch of the saphenous nerve (IBSN) is a cutaneous sensory nerve arising from the saphenous nerve in the adductor hiatus. The IBSN then innervates the anteromedial aspect of the knee and the anterior-inferior portion of the knee capsule. Surgical approaches to the anteromedial side of the knee can cause injury to the IBSN and even post-operative neuromas at the transection of nerve. The IBSN injury typically cause loss of sensation, paresthesia, neuralgia or hypersensitivity in the medial infrapatellar area. This report shows an atypical case of the IBSN injury in that the presenting symptom is pain on the lateral aspect of the proximal leg.
[Case]
A 37-year-old man experienced tingling sensation & hypesthesia on the right proximal lateral leg after Rt. ACL reconstruction with allogenic tibialis tendon. Physical examination revealed that knocking on the anteromedial aspect of the knee provokes pain on the lateral aspect of the proximal part of the lower leg.
Electrodiagnostic findings were compatible with the right saphenous neuropathy. Sonography revealed that the hypoechogenic, heterogenous cyst or neuroma around right IBSN. He was diagnosed with the post-operative neuroma on IBSN, even though he didn’t present the typical pain on the medial infrapatellar area. He underwent a local steroid injection for hydrodissection around the neuroma and a temporary improvement in symptoms was noticed after the injection.
[Conclusions]
IBSN injury is usually in concern when surgeons encounter a patient with anteromedial knee pain. But injury to the IBSN can also result in sensory problems on the proximal lateral part of the lower leg.
Considering the high variability of the IBSN, physicians should be aware of possibility of IBSN injury in patients after knee sugery if they experience sensory problem of the lower leg.
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Figure 1. Sonographic finding showing hypoechogenic, heterogenous cyst or neuroma around the infrapatellar branch of right saphenous nerve
Figure 2. Sonographic finding after local steroid injection for hydrodissection around the neuroma
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