PMC7210923_01
Pre-operative radiograph. Left knee, lateral view.
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F1
Pre-operative radiographs (Fig. 1) demonstrated a prominent tibial tuberosity but no other pathology.
Post-operative radiographs. Left knee, lateral view.
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F2
Post-operative radiographs demonstrate the appearances after tibial tuberosity exostectomy (Fig. 2).
First surgery - scar location.
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F3
A few weeks after the tibial tuberosity exostectomy, the patient noted pain localized to the anteromedial region of the knee joint, at the surgical scar (Fig. 3), that was different in character to the pre-operative symptoms. Physical examination revealed features of allodynia with increased pain even on light palpation, dysesthesia, and a positive Tinel's test at the scar (Fig. 3).
Second surgery per-operative view.
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F4
The two branches of the IBSN were identified (Fig 4a and b). The first branch (X), ending with a neuroma, was neurolyzed and resected with the surrounding scar tissue (Fig 4c). The end of the nerve, after cauterization, was buried deep in healthy tissue (Fig. 4d: X). The second branch was neurolyzed only (Fig. 4 a, b, c: Y).