Long-term clinical outcomes of genicular nerve radiofrequency ablation for chronic knee pain using a three-tined electrode for expanded nerve capture

Abstract

ObjectiveGenicular nerve radiofrequency ablation (GNRFA) is an effective treatment option for chronic knee pain in native knee osteoarthritis and total knee arthroplasty (TKA) patients. Recent dissections have revealed significant variability in typical genicular nerve targets and other sensory nerves not included in previous studies. Early, short-term results suggest that more complete sensory denervation with GNRFA may result in more significant pain reduction; however, no long-term clinical outcome exists. We aim to present long-term clinical outcomes after an expanded GNRFA technique with a three-tined radiofrequency cannula. MethodsEleven consecutive patients with ≥6 months of knee pain underwent an expanded GNRFA protocol targeting the superomedial (SMGN), superolateral (SLGN), inferomedial genicular nerves (IMGN), in addition to the nerves to vastus medialis (NVM), lateralis (NVL), and intermedius (NVI). Long-term pain and impression of change outcomes were collected in a cross-sectional fashion. ResultsAt ≥18 months (mean 24 months) post-GNRFA, 91% (95% CI ​= ​59, 100%), 73% (95% CI ​= ​46, 99%), and 9% (95% CI ​= ​0, 26%) of patients reported ≥50%, ≥80%, and 100% pain relief, respectively. Additionally, 27% (95% CI ​= ​1, 54%) and 64% (95% CI ​= ​35, 92%) of individuals reported a PGIC score of 6 (“much improved”) and 7 (“very much improved”), respectively. The proportion of individuals who reported the MCID for the PGIC (score of ≥6) was 91% (95% CI ​= ​59, 100%). There were no adverse events reported amongst the patients in this cohort. No patients progressed to surgery. ConclusionThis single-arm cohort suggests that an expanded GNRFA protocol targeting SMGN, SLGN, IMGN, NVM, NVL, and NVI nerves with a three-tined electrode, resulted in significant long-term (≥18 months) improvements in pain and patient-perceived global improvement. Large, head-to-head trials are needed to establish whether this GNRFA protocol is superior to those used in previous clinical studies and those currently used more commonly in practice.