Michael S. Glicksman, MD
Resident Physician
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
David Rivetti, MD
Resident Physician
UPMC Department of Physical Medicine & Rehabilitation
Pittsburgh, Pennsylvania, United States
Natalie D. Curley, DO
Resident Physician
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Nicholas M. Tranchitella, MD
Resident Physician
UPMC
Pittsburgh, Pennsylvania, United States
Clayton C. Bunting, DO
Resident
University of Pittsburgh Medical Center
pittsburgh, Pennsylvania, United States
Ryan Mortman, MD
Resident
UPMC
Pittsburgh, Pennsylvania, United States
William Schultze, DO
Resident Physician
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Krish T. Bharat, MD (he/him/his)
Resident Physician
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Michael Heslin, DO
Fellow
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Trent Emerick, MD, MBA
Associate Professor and Program Director
UPMC Department of Anesthesiology and Perioperative Medicine
Pittsburgh, Pennsylvania, United States
Chronic knee pain
Case Description:
22-year-old soccer player presented to clinic with refractory, chronic right medial knee pain. He experienced a traumatic displaced bucket-handle tear of the medial meniscus four years prior that was surgically repaired. Post-operatively, he had continued pain with repeat MRI suggestive of recurrent medial meniscus tear with grade 3 chondrosis at the medial femoral condyle and tibial plateau. He then underwent partial medial meniscectomy and chondroplasty of the medial femoral condyle and tibial plateau, but, experienced persistent pain that limited his daily/athletic function. He attempted PT, bracing, viscosupplementation, and corticosteroid injections without benefit. Patient was subsequently referred to chronic pain clinic and underwent right medial superior and inferior genicular nerve blocks with 90% pain relief. Given this benefit, he underwent right genicular nerve cooled radiofrequency ablation (RFA) with improvement in pain and function thus far.
Discussions:
Young athletes with persistent, uncontrolled pain are at risk for activity limitation, physical/mental health comorbidities, and decreased quality of life1. When chronic knee pain does not improve with conservative management, additional modalities may be employed – each with potential detriments. Pharmacological agents may result in misuse, dependency, and various adverse side effects2. Repeated corticosteroid injections may cause joint destruction and tissue atrophy3. Finally, surgical interventions include pre-, peri-, and post-operative risks, and knee replacements in younger patients are associated with higher rates of revision4. Cooled RFA is an FDA-approved, low-risk procedure for chronic, refractory knee pain in patients with radiologically-confirmed osteoarthritis and >50% improvement following diagnostic genicular nerve block5. While prior studies have demonstrated safety and efficacy in an older population, this case demonstrates the utility of genicular nerve RFA in a young adult6.
Conclusions:
Young athletes with chronic knee pain are predisposed to a multitude of pain-related and iatrogenic complications. When indicated, cooled RFA may serve as a safe and efficacious treatment modality.
