Chronic pain around the knee joint has been and continues to remain a challenging problem. This is primarily related to the fact that the neural pathways responsible for the pain have been poorly understood. However, recent anatomical studies detailing these neural pathways have facilitated our understanding of the sensory mechanisms responsible for pain around the knee joint.1 This has greatly enhanced our ability to evaluate, diagnose, and manage patients with chronic and intractable knee pain. Unfortunately, there are only scattered reports in the literature describing these conditions and the appropriate treatments.Denervation for chronic joint pain was initially described in 1958.2,3 Early reports of total denervation for chronic pain about the elbow joint were not well accepted due to the untoward effects on extremity function. This is because both sensory and motor nerves were ablated. Thus, for many years, denervation was not considered a reasonable option. However, with the advent of selective denervation, the untoward sequellae have been eliminated because only the specific sensory nerves are excised.4,5 Thus, in properly selected patients, a significant to complete reduction in pain is possible. It is important to realize, however, that selective denervation is primarily directed at patients with neuromatous pain. It is not recommended for chronic pain resulting from a nonneuromatous etiology. Selective denervation for chronic neuromatous knee pain was initially described by Dellon et al. in 1995.6 In his pilot study, 15 patients with persistent neuromatous pain following total knee arthroplasty were treated. All patients reported a reduction in pain. Mean follow-up was 12 months. In a subsequent study, 70 patients with chronic neuromatous knee pain following total knee arthroplasty, trauma, or osteotomy had selective denervation with a good to excellent outcome in 86% with a mean follow-up of 24 months.7 These studies have provided the basis for further investigation.
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