An ancient treatment for present-day surgery: Percutaneously freezing sensory nerves for treatment of postsurgical knee pain

The analgesic properties of cold therapy have been well known for many centuries. Cryoneurolysis of sensory peripheral nerves, in which the epineurium and perineurium resist freeze damage, allowing the structural scaffold to remain intact for normal axonal regeneration and remyelination to occur, has been used to treat pain for many decades. Chronic knee pain due to osteoarthritis is a common condition associated with significant disability among the elderly. Because no single treatment modality has been shown to be effective for treatment of knee pain secondary to osteoarthritis, treatment usually involves a combination of nonpharmacologic (including total knee arthroscopy) and pharmacologic therapies. Given the paucity of effective nonsurgical options for the treatment of knee pain, cryoneurolysis of the sensory nerves surrounding the knee may be a novel effective treatment strategy. Because cutaneous innervation of the knee is highly variable and complex, additional research is needed to understand which sensory nerves should be targeted for cryoneurolysis to maximize effectiveness. Recent advances in cryoneurolysis technology have allowed for the creation of more precise cold zones using smaller gauge needles that cause less pain when puncturing the skin. Emerging evidence suggests that this technology has clinical utility when used as part of a multimodal pain regimen for total knee arthroplasty. In addition to its potential to treat chronic knee pain, cryoneurolysis of sensory nerves has shown efficacy for the temporary relief of pain caused by numerous conditions.