607 - Long-Term Reliable Analgesia from Cryoneurolysis treatment of post-traumatic osteoarthritis of the ankle

This now 35-year-old female was in a MVA 10 years ago where she had a right calcaneus fracture, and talar dome osteochondral lesion treated with ATFL repair, ankle debridement, and grafting procedure. Patient continued to have chronic right ankle pain not improved by repeat arthroscopy, oral medications, or therapies. The patient complained of deep anterior ankle pain radiating up the leg and into the knee with numbness and tingling into the toes. Patient was referred to a physiatrist who provided treatment with cryoneurolysis of the right superficial fibular nerve (iovera°, Pacira Biosciences, La Jolla, CA). Patient had significant improvement of pain and function with this initial procedure. Repeat procedures included addition of the right deep fibular nerve cryoneurolysis each 5–8-months for continued pain relief for 7 years. The patient has consistently had significant improvements in her pain for at least five but up to eight months with no side effects.

Conclusions: Post-traumatic ankle osteoarthritis is a difficult condition to treat, given limited improvement with bracing and injections and the undesirability of ankle fusion and arthroplasty. This case demonstrates that cryoneurolysis may provide both analgesia and near normal function over at least a 7-year duration in patients with chronic post-traumatic osteoarthritis. The reliability of cryoneurolysis to consistently improve pain and function with a consistent duration of relief with repeat treatments over seven years supports the effectiveness of this procedure for patients with this condition. This case report provides information that could inform providers about the potential benefits of this procedure for recalcitrant ankle pain.