372 posters, 1 audios, 13 topics, 29 sessions, 1,035 authors, 449 institutions

51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting

April 16 - 18, 2026 | Phoenix, Arizona

2358423

Nerve Hydrodissection as a Treatment Option for an Infrapatellar Branch of the Saphenous Nerve Neuroma After ACL Reconstruction

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Poster Presenter

Leigh Anne Kline

Authors

Kara McConaghy, Reid Collis, Leigh Anne Kline, David Hryvniak

Affiliations

null,

Part of Topic

Late Breaking Medically Challenging Cases

Iatrogenic injury of the infrapatellar branch of the saphenous nerve (IPBSN) is a common cause of neuropathic pain following ACL reconstruction, with incidence of IPBSN injury ranging from 14.9-77% depending on surgical technique and graft type. Damage may occur during hamstring or bone-patellar tendon-bone (BTB) autograft harvesting, with direct transection, stretching, or compression during the surgical approach comprising the most common mechanisms of injury. More than 40% of patients report continued paresthesias at 1-year follow-up.

•45y Male

•Initial date of injury: April 2025, while playing soccer, heard a “pop” during a cutting motion

•MRI 04/14/25: “Complete tear of the ACL, deep MCL meniscofemoral ligament, and femoral attachment of the MPFL. Partial tear of the popliteofibular ligament. Complex tear of the medial meniscus posterior horn and root.”

•Underwent left knee arthroscopic ACL reconstruction using quadriceps autograft and left partial medial meniscectomy 05/12/25.

•No pain and progressing as expected on follow ups 06/2/25 and 07/17/25, noted to have infrapatellar paresthesias at 5-mo follow up 10/16/25.

•Underwent 3-rounds of IPBSN hydrodissection

•10/29/25: 8mL Lidocaine 1%; <1d of 80-90% improvement

•11/5/25: 8mL Lidocaine 1%, Triamcinolone 20mg, Ketorolac 5mg; 3mo of 80% relief

•02/23/26: 8mL Lidocaine 1%, 20mg Triamcinolone, 20-40% further relief

IPBSN injury is a common cause of neuropathic pain following ACL reconstruction surgery. While sensory abnormalities tend to improve with time, they rarely resolve completely and can substantially contribute to postoperative morbidity3. Nerve hydrodissection under ultrasound guidance is a novel approach to management of these nerve injuries and may provide a simple and effective treatment to chronic neuropathic pain as a result of IPBSN injury.