Systematic Review and Meta-analysis of Radiofrequency Ablation for Morton's Neuroma: Outcomes and Predictors of Success.

Abstract

Morton's neuroma presents a challenge in terms of pain management. This study aimed to evaluate the available evidence on the efficacy and safety of radiofrequency ablation for Morton's neuroma. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. Prospective clinical trials, cohort studies, and case series were also included. Data analysis was performed using Review Manager 5.4. Meta-analysis applied fixed- or random-effects models depending on the heterogeneity. Sensitivity analyses were performed to assess the effects of temperature, radiofrequency cycles, and imaging guidance. Eight studies ( N = 237) were included. Significant pain reduction was observed at the final follow-up (mean difference = 5.74; 95% confidence interval = 5.58, 5.90). At the final follow-up, 47.57% (95% confidence interval = 25.13%-70.00%) experienced complete pain relief, while 16.40% (95% confidence interval = 11.86%-20.94%) reported no benefit at final follow-up. Sensitivity analyses found higher-temperature settings (≥85°C) conferred greater relief on visual analog scale (mean difference = -6.97; 95% confidence interval = -6.75 to -7.18) compared to temperatures <85°C (mean difference = -3.94; 95% confidence interval = -3.68 to -4.19). Fewer radiofrequency cycles (≤3) also demonstrated significantly greater visual analog scale improvement (mean difference = -6.97; 95% confidence interval = -6.75 to -7.18) versus >three cycles (mean difference = -4.79; 95% confidence interval = -3.02 to -6.57). Complications were minimal (2.1%), and most resolved without significant interventions. Radiofrequency ablation, particularly at specific temperatures and cycle thresholds, is effective and safe for the management of Morton's neuroma. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of this article, the reader should be able to: 1): Determine the effect of knee extensor muscle strength changes on the medial and lateral meniscus, tibia, and medial and lateral femoral cartilage over 2 yrs in mild to moderate knee osteoarthritis patients; 2): Describe the correlation of knee extensor strength with the medial and lateral meniscus, tibia, and medial and lateral femoral cartilage at different WOMAC-pain levels; and 3): Discuss the relationship between changes in muscle strength and changes in meniscus and cartilage volume and WOMAC pain scores over 2 yrs in mild to moderate knee osteoarthritis patients. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.