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Under a Creative Commons license Open access AbstractSubchondral insufficiency fractures of the knee are commonly misdiagnosed fractures that are both very painful and difficult to treat. A conservative treatment modality to control symptoms during rehabilitation has not previously been described. This case report presents the alternate use of cooled radiofrequency ablation technique of the genicular nerves for pain relief and bisphosphonate infusion to address the underlying poor bone mineralization/density with imaging follow-up before and after instituted treatments. A middle-aged female patient presenting with atraumatic pain in the medial aspect of the left knee diagnosed on an original magnetic resonance imaging as an insufficiency fracture and debilitating pain. Multiple-surgeon opinions of total knee arthroplasty were not a consideration the patient wanted or could consider given her lifestyle. Cooled radiofrequency ablation of the genicular nerve branches was performed with significant-complete pain relief achieved that lasted at least 6 months. Bisphosphonate infusions were instituted to address the underlying osteoporosis detected by a dual energy X-ray absorptiometry (DEXA) scan. Clinical performance after the radiofrequency ablations was followed with clinically validated surveys (The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)/Knee Injury and Osteoarthritis Outcome Score (KOOS)) at 2 weeks, 1, 3, and 6 months. Patient was also asked to follow a restricted-modified weight-bearing plan for 3 months followed by physical therapy. Eight weeks apart of bisphosphonate infusions were delivered after proper administration of vitamin D. There was resolution of the insufficiency fracture at the medial femoral condyle between the magnetic resonance imaging exams within 4.5 months apart treated with restricted weight-bearing regimen. Pain resolution, significant improved function, and range of motion were the end results of our instituted treatment plan. This case reports presents an alternate pathway for the treatment of this condition especially when there is lack of consensus among physicians in how to best address this condition. KeywordsKnee SIFK MRI Bisphosphonate Ablations Cited by (0)© 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington. This site uses cookies to improve performance. If your browser does not accept cookies, you cannot view this site. Setting Your Browser to Accept CookiesThere are many reasons why a cookie could not be set correctly. Below are the most common reasons:
Why Does this Site Require Cookies?This site uses cookies to improve performance by remembering that you are logged in when you go from page to page. To provide access without cookies would require the site to create a new session for every page you visit, which slows the system down to an unacceptable level. What Gets Stored in a Cookie?This site stores nothing other than an automatically generated session ID in the cookie; no other information is captured. In general, only the information that you provide, or the choices you make while visiting a web site, can be stored in a cookie. For example, the site cannot determine your email name unless you choose to type it. Allowing a website to create a cookie does not give that or any other site access to the rest of your computer, and only the site that created the cookie can read it. How do you treat a subchondral fracture?Subchondroplasty is a technique indicated for treatment of early subchondral fractures or stress related marrow edema associated with osteoarthritis and involves the injection of synthetic calcium phosphate into the trabecular space, providing mechanical support.
What is subchondral insufficiency fracture?Subchondral insufficiency fractures (SIF) are a type of stress fracture which occurs below the cartilage on the weight bearing surface of a bone. SIF occur when normal physiological forces are repeatedly applied to an area of bone compromised by non-tumorous disease, resulting in fracture.
What is treatment of insufficiency fracture?These fragility pelvic fractures can be painful and are treated with rest, minimizing weight bearing with a walker or crutches, rehabilitation by physiotherapist, and treating the patient with supplemental calcium and vitamin D. These fractures can take 3 to 4 months to heal.
What is an insufficiency fracture of tibia?A subchondral insufficiency fracture is a type of stress fracture that occurs when bone underlying the cartilage in a joint is unable to bear stresses normally subjected to the joint.
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Subchondral insufficiency fracture of the medial tibial plateau
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