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Introduction <p>Postoperative neuralgias are common complications following orthopedic surgeries, particularly after knee ligament surgeries. This case report presents the treatment of postoperative saphenous nerve neuralgia with Onabotulinumtoxin A in a 45-year-old patient after a complex knee joint surgery.</p> Case Description <p>The patient suffered a complex injury to the right knee joint, including a tear of the anterior cruciate ligament and the medial collateral ligament, as well as avulsion of the anteromedial joint capsule. In the postoperative course after cruciate ligament replacement with quadriceps tendon and open medial ligament reconstruction with gracilis tendon, the patient developed severe neuropathic pain (allodynia, burning sensations) at the medial ligament scar. Initially, treatment involved local anesthetics, pregabalin, and tramadol. With no therapeutic success, a subcutaneous injection of 30 units of Onabotulinumtoxin A (Xeomin) was administered three weeks postoperatively, resulting in rapid improvement of symptoms and near-complete resolution, particularly of the allodynia. After about six months, there was a resurgence of pain, especially the allodynia. A repeat injection treatment with 30 units of Onabotulinumtoxin A again led to significant improvement in symptoms as described above.</p> Conclusion <p>The application of Onabotulinumtoxin Type A may serve as an effective therapeutic option for treating postoperative neuropathic pain, especially in cases that do not respond to conventional pharmacological and physical therapies. Further research is needed to verify the reproducibility of treatment success and to determine optimal dosages and potential injection intervals.</p>

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Behandlung einer postoperativen Nervus-saphenus-Neuralgie nach Innenbandrekonstruktion mit Botulinumtoxin

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月29日

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  • Maurice Balke,
  • Jürgen Höher,
  • Ralph Akoto,
  • Tobias Drenck,
  • Lena Eggeling,
  • Maryam Balke

摘要

Introduction

Postoperative neuralgias are common complications following orthopedic surgeries, particularly after knee ligament surgeries. This case report presents the treatment of postoperative saphenous nerve neuralgia with Onabotulinumtoxin A in a 45-year-old patient after a complex knee joint surgery.

Case Description

The patient suffered a complex injury to the right knee joint, including a tear of the anterior cruciate ligament and the medial collateral ligament, as well as avulsion of the anteromedial joint capsule. In the postoperative course after cruciate ligament replacement with quadriceps tendon and open medial ligament reconstruction with gracilis tendon, the patient developed severe neuropathic pain (allodynia, burning sensations) at the medial ligament scar. Initially, treatment involved local anesthetics, pregabalin, and tramadol. With no therapeutic success, a subcutaneous injection of 30 units of Onabotulinumtoxin A (Xeomin) was administered three weeks postoperatively, resulting in rapid improvement of symptoms and near-complete resolution, particularly of the allodynia. After about six months, there was a resurgence of pain, especially the allodynia. A repeat injection treatment with 30 units of Onabotulinumtoxin A again led to significant improvement in symptoms as described above.

Conclusion

The application of Onabotulinumtoxin Type A may serve as an effective therapeutic option for treating postoperative neuropathic pain, especially in cases that do not respond to conventional pharmacological and physical therapies. Further research is needed to verify the reproducibility of treatment success and to determine optimal dosages and potential injection intervals.