We retrospectively reviewed the cases of fourteen patients who had
reflex sympathetic dystrophy of the knee. All fourteen were hospitalized,
and epidural block anesthesia was instituted with an indwelling catheter
for an average of four days, during which continuous passive motion,
manipulation (as necessary), stimulation of muscles, and alternating hot
and cold soaks were used. The average length of follow-up was thirty-two
months. Eleven patients had complete resolution of the symptoms, two had
sufficient intermittent aching with changes in the weather to need
medication, and one had no relief. The diagnosis was confirmed if the
symptoms were relieved by a lumbar sympathetic block. Pain that was out of
proportion to the severity of the injury was the most consistent finding,
being present in all fourteen patients. However, variation in clinical
severity is characteristic of the syndrome. Eleven of the fourteen patients
had had a previous patellar operation. After the onset of the symptoms,
nine patients had two or more arthroscopic examinations, without notable
findings. All fourteen patients had had extensive physical therapy and
medical treatment before the epidural block was performed.