Partial Joint Denervation II: Knee and Ankle

Background: Partial joint denervation is the concept of preservation of joint function and relief of joint pain by interrupting neural pathways that transmit the pain message from the joint to the brain. Partial denervation of painful wrist, elbow, and shoulder joints was described in part I. Application of these principles to the knee and ankle is described in part II. Methods: Cadaveric anatomical studies identified innervation of the knee and the ankle (sinus tarsi) to provide a guide to nerve blocks and surgical intervention. Patients were evaluated who had sports injuries, trauma, osteoarthritis, or previous arthroplasty/scope procedures of the knee and/or ankle who failed to respond to traditional musculoskeletal approaches. Results: The results obtained for partial joint denervation of the upper extremity can be applied successfully to the knee and ankle joints. If anesthetic block of joint innervation results in a reduction of 5 or more the visual analogue scale, 90 percent of the patients can expect good to excellent pain relief from partial joint denervation. Conclusions: For patients with a structurally intact joint but with chronic knee or ankle pain after trauma or arthroplasty, this approach provides an outpatient, ambulatory operative approach that is joint sparing and can be rehabilitation-free. Partial joint denervation in the lower extremity offers plastic surgeons the opportunity to help our colleagues in orthopedic surgery, podiatric medicine, and pain management with some of their most difficult pain-related lower extremity patient problems. (Plast. Reconstr. Surg. 123: 208, 2009.)