EFFECT OF SAPHENOUS NERVE RELEASE ON PATIENTS WITH PATELLOFEMORAL PAIN SYNDROME

Cairo University (CU)

Status: Enrolling

Conditions: Patellofemoral Pain Syndrome

Treatments: Other: Saphenous nerve release

Study type: Interventional

Funder types: Other

Identifiers

NCT07318987

P.T.REC/012/006114

Details and patient eligibility

About

Patellofemoral Pain Syndrome (PFPS) is a frequent cause of anterior knee pain in young, physically active individuals, especially females, and is commonly managed with quadriceps and hip-focused exercises. However, the role of neural factors has been largely overlooked. The saphenous nerve, which supplies sensation to the anteromedial knee, may become irritated or entrapped and contribute to pain and neuromuscular dysfunction in PFPS. This study suggests that manual therapy targeting the saphenous nerve could improve pain, function, and balance, providing a more holistic approach to PFPS rehabilitation.

Full description

Patellofemoral Pain Syndrome (PFPS) is a common cause of anterior knee pain, particularly affecting adolescents and young adults, with a higher prevalence among females. It accounts for a significant proportion of knee complaints seen in sports medicine and is especially common in physically active individuals. Traditional rehabilitation for PFPS has mainly focused on quadriceps strengthening and knee mechanics, with more recent attention given to hip-focused exercises.

However, the neural contribution to PFPS, particularly involving the saphenous nerve and its infrapatellar branch, has been relatively under-explored. The saphenous nerve is a purely sensory branch of the femoral nerve that supplies the anteromedial knee and lower leg and plays an important role in proprioception. Anatomical variations and its course near the sartorius muscle may predispose it to irritation or entrapment, potentially contributing to chronic anteromedial knee pain.

This study proposes that irritation or mechanosensitivity of the saphenous nerve may be a contributing factor in PFPS, leading to pain and impaired neuromuscular control. By incorporating manual therapy targeting the saphenous nerve, the research aims to fill a gap in current PFPS management. Addressing neural factors may enhance pain reduction, functional performance, and balance, offering a more comprehensive and holistic physiotherapy approach for individuals with PFPS. (summarize in short)

Enrollment: 36 estimated patients

Sex: All

Ages: 18 to 35 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1 - Age from 18 to 35 and BMI 18 to 25 kg/m2. 2. Both gender (male and female) 3. Patients who had anterior knee pain for at least six weeks 4. Patients with positive saphenous neurodynamic test (SAPHNT)

Exclusion criteria

1. Knee replacement
2. An intraarticular injection within the past 3 months
3. Previous operative treatment or arthroscopy, other secondary knee-related problems (bursitis, tendinopathy, osteochondritis, neuromas, intraarticular pathology (such as osteoarthritis), tumor, and rheumatologic diseases
4. Diabetic neuropathic pain or fibromyalgia

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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36 participants in 2 patient groups

SAPHENOUS NERVE RELEASE

Experimental group

Description:

The patient is in a supine position with the leg extended. Look for a sensitive area four to five fingerbreadths above the knee on the medial side. This will be a long strip of fascia that is several inches in length. The fingers are then placed on either side of this strip on the medial side of the leg behind the sartorius muscle. The fingers are pulled apart in distal and proximal directions, as if to separate the strip as far as possible

Treatment:

Other: Saphenous nerve release

traditional treatment

Active Comparator group

Description:

The intervention program lasted six weeks and was performed three times per week. It included strengthening, manual therapy, and stretching exercises. Strengthening focused on both the hip and knee. Hip exercises consisted of side-lying hip abduction, clamshells, and prone hip extension, while knee exercises included straight leg raises, terminal knee extensions, and wall-supported mini-squats. Exercises progressed from 3 sets of 10 to 3 sets of 20 repetitions, with gradual resistance added, dynamic execution, brief pauses between repetitions, and short rest periods between sets. Manual therapy involved patellofemoral joint mobilization performed in a supine position with the knee slightly flexed, using superior, inferior, medial, and lateral patellar glides. Stretching exercises were performed in sitting or standing, targeting the posterior structures with the knee extended and ankle dorsiflexed. Static stretches were held for 15 seconds and repeated for three sets.

Treatment:

Other: Saphenous nerve release