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Final Program


Final Program

Musculoskeletal

936 - Case Report: Turning Failure Into Opportunity: Prime Time for Personalized Multimodal Treatment

Thursday, February 19, 2026
5:00 PM - 6:30 PM AST

    Presenting Author(s)

  • GQ

    Gary Qiao, MD Candidate

    Medical Student M1
    California University of Science and Medicine
    RANCHO CUCAMONGA, California, United States

    • Corresponding Author(s)

  • VJ

    Vance Z. Johnson, MD

    Professor of Medical Education
    California University of Science and Medicine
    Temecula, California, United States

    • Co-Author(s)

  • HB

    Harbir Bhatti, MD Candidate

    Medical Student
    California University of Science and Medicine
    Anaheim, California, United States

    • Submitter(s)

  • GQ

    Gary Qiao, MD Candidate

    Medical Student M1
    California University of Science and Medicine
    RANCHO CUCAMONGA, California, United States

Case Diagnosis: Knee osteoarthritis (OA) is a heterogeneous, multifactorial disease with variable response to standard interventions. Persistent pain after arthroscopy presents a therapeutic challenge, often requiring individualized, multimodal care.

Case Description: A 62-year-old female with radiographic Kellgren-Lawrence grade III knee OA underwent arthroscopic debridement for persistent pain and mechanical symptoms. Postoperatively, the patient experienced declining participation and worsening OA symptoms. A more aggressive, individualized rehabilitation protocol was initiated, combining extracorporeal shock wave therapy (ESWT), peripheral nerve blocks, and adjunctive physical modalities. At 8 weeks, the patient demonstrated clinically significant improvement in pain (VAS reduction of 2.5 points) and function (WOMAC improvement of 15 points), with increased range of motion and reduced suprapatellar effusion on ultrasound. These findings were sustained at the 3-month follow-up. The patient resumed low-impact exercise and reported high satisfaction with the individualized, aggressive approach.

Discussions:

Physiatrists taught that the “Prime Time” to treat patients for the greatest gain of function is in the first few months after surgery. Unfortunately, this window is underutilized in patients transitioning from acute inpatient care to rehabilitation care. 


Literature supports the use of ESWT as a safe, effective adjunct for short-term pain and function improvement in knee OA. Additionally, peripheral nerve blocks are effective for pain control and enable more intensive rehabilitation participation. Network meta-analyses and cohort studies highlight the superiority of individualized, multimodal protocols—combining ESWT, nerve blocks, and physical modalities—for optimizing pain relief, functional gains, and patient engagement in therapy.

Conclusions:

There are no randomized controlled trials that aim to guide the sequencing or combination of multimodal therapies in this “failed” arthroscopy subgroup. This case highlights a tailored, individualized, multimodal approach to capitalize on this “Prime Time” window for patients with “failed” knee OA arthroscopies. Ongoing research is needed to refine patient selection, dosing, and long-term protocols for these combination strategies.