AB279. SOH26AB_0179. Paired anserine hydrodissection and knee joint injection for the management of knee pain: a case report

Background: Joint pain can have multiple simultaneous sources of pain. There is the joint cartilage, tendons, and ligaments as potential sources of pain. One treatment may be suitable for one source of pain but not another. Multiple simultaneous treatments may improve treatment outcomes.

Case Description: We present the case of a 42-year-old woman presenting to the pain clinic with chronic right medial knee pain with magnetic resonance imaging (MRI) proven tricompartmental osteo-arthritis, anserine bursitis, and cartilaginous degeneration. The patient was experiencing substantial impairment in both activity levels and in ability to provide care for her elderly mother, but was reluctant to consider arthroplasty due to her age. A theatre-based, ultrasound-guided combination of hydrodissection of the anserine bursa with 10 mL of 5% dextrose and knee joint injection with 9 mL 0.25% bupivacaine, 40 mg triamcinolone, and 20 mg hyaluronate (Hyalgan) was performed for the patient to address each element contributing to her chronic knee pain. This combination offered both the expected benefits of steroid and hyaluronate, combined with additional targeted therapy of perineural inflammatory change. Following this intervention, the patient exhibited substantial improvement in both reported pain scores and activity levels at the initial 2-week and subsequent 2-month follow-up. No complications were reported.

Conclusions: This case supports 5% dextrose hydrodissection as a safe addition to established interventional joint injection where multiple pain sources in a joint are identified. Substantial sustained improvement was achieved following injections, with no complications. Further investigation into the potential synergy between these combined techniques merits investigation.

Keywords: Hydrodissection; joint pain; multiple treatment; pain medicine; case report