Ultrasound-Guided Geniculate Nerve Block in Combination with Intra-Articular Morphine Injection for Chronic Knee Pain Secondary to Patellar Fracture: A Case Report

Abstract

Background: Patellar fractures represent approximately 1% of all skeletal fractures, with a peak in young adults due to high-energy trauma and another in older adults due to bone fragility. Patients typically present with pain, joint effusion, and a palpable separation of the patella or extensor mechanism insufficiency, resulting in the inability to perform a straight leg raise. Aims: Chronic knee pain following patellar fractures presents a therapeutic challenge when it persists despite conservative management. Case presentation: It is present a case of a patient with refractory chronic pain following a patellar fracture and concomitant posterior cruciate ligament (PCL) injury, successfully treated with ultrasound-guided geniculate nerve blocks (superomedial, superolateral, and inferomedial) combined with intra-articular morphine injection. The relevant anatomy, ultrasound approach, and clinical course are described. Conclusion: This case supports the combined use of minimally invasive interventional techniques as an alternative for chronic post-traumatic knee pain.