Background: Fluoroscopically guided cooled genicular nerve radiofrequency ablation (RFA) is an increasingly performed procedure for chronic, refractory knee pain due to osteoarthritis. Traditionally, partial sensory denervation has been accomplished through ablation of the superomedial, superolateral, and inferomedial genicular nerves. However, recent cadaveric studies have demonstrated additional sensory nerves and significant anatomic variation that impact current protocols.
Objective: We describe an updated cooled genicular nerve radiofrequency ablation protocol that accounts for varied nerve location of the superomedial, superolateral, and inferomedial genicular nerves, as well as capture of the terminal articular branches of the nerves to the vastus intermedius, vastus lateralis, and vastus medialis. Furthermore, we describe an adjusted technique for inferomedial genicular nerve capture that mitigates the risk of pes anserine tendon injury.
Design: Technical report and brief literature review.
Methods: Cadaveric studies relating to the sensory innervation of the anterior knee joint were reviewed, and a more accurate and comprehensive cooled genicular nerve radiofrequency ablation (CRFA) protocol is proposed.
Conclusions: Based on recent, rigorous anatomic dissections of the knee, the proposed genicular nerve CRFA protocol will provide more complete sensory denervation and potentially improve clinical outcomes. Prospective studies will be needed to confirm the hypothesis that this protocol will result in improved effectiveness and safety of genicular nerve RFA.
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http://dx.doi.org/10.1093/pm/pnz124 | DOI Listing |
Medicine (Baltimore)
January 2025
Uenohara Kajitani Orthopaedics, Uenohara, Yamanashi, Japan.
Rationale: Chronic knee pain is a common health issue that requires effective and noninvasive treatment. We devised a novel noninvasive approach using ultrasound-guided electrical nerve reactivation (ENR) in which ultrasound is used to identify the genicular nerve (GN). Then, transcutaneous low-frequency stimulation is applied for 10 seconds.
View Article and Find Full Text PDFBr J Anaesth
January 2025
Department of Theatres, Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK.
Total knee arthroplasty is a life-changing surgical procedure that is associated with a high incidence of severe postoperative pain. Key to enhancing recovery after surgery is effective analgesia and early mobilisation. Innovations in motor-sparing regional anaesthesia techniques that have improved recovery include targeted surgical local infiltration analgesia, adductor canal blockade, genicular nerve blocks, and the infiltration between the popliteal artery and posterior capsule of the knee (iPACK) block.
View Article and Find Full Text PDFKorean J Pain
January 2025
Division of Pain Medicine, Department of Anesthesiology, Reanimation, and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
Sports Med Arthrosc Rev
October 2024
Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
This study was to investigate the efficacy of ultrasound-guided genicular nerve block for patients who underwent knee arthroscopy. Patients were randomized into two groups: 1. nerve block group: ultrasound-guided genicular nerve block (superomedial, superolateral and inferomedial genicular nerve, 2-ml 0.
View Article and Find Full Text PDFOchsner J
January 2024
Department of Anesthesiology, Super Specialty, MGM Medical College, Indore, India.
Knee osteoarthritis is a chronic degenerative disease associated with pain and decreased mobility that affects advanced-age individuals, thus causing further debilitation. Radiofrequency ablation can benefit patients who are not ideal candidates for surgical intervention and for whom conservative management has been unsatisfactory. Currently, radiofrequency ablation is performed using either ultrasonography or fluoroscopy.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!