Ultrasound-guided Genicular Nerve Radiofrequency Treatment-Three- versus Five-Nerve Protocol: Prospective Randomized Comparative Trial.

Abstract

Genicular nerve radiofrequency (RF) procedure is increasingly being performed to treat chronic pain due to knee osteoarthritis (OA). Targeting additional sensory nerves and improving target identification by using ultrasound (US) guidance may improve treatment success. The aim of this study was to compare the effectiveness of traditional genicular nerves versus two additional sensory nerves to traditional genicular nerves for US-guided genicular nerve RF procedures in patients with chronic knee OA. A total of 80 patients were randomized into two groups. Patients in the three-nerve targeted (TNT) group received a genicular RF with traditional genicular nerves; superior lateral, superior medial, and inferior medial nerves, and the five-nerve targeted (FNT) group received a genicular RF with recurrent fibular and infrapatellar branch of the saphenous nerve in addition to the traditional genicular nerves. Numerical Rating Scale (NRS), Short Form-36 (SF-36), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Quantitative analgesic questionnaire (QAQ) and patient satisfaction were evaluated at pretreatment, at week 1, months 1,3,6. Both techniques provided significant pain reduction and functional improvement up to six months post-procedure (p < 0.05). The FNT group showed significant improvement with respect to the NRS, WOMAC total and SF-36 score compared to the TNT group at each follow-up point. No differences in QAQ or patient satisfaction scores were observed between both groups. The US-guided five-nerve targeted technique is a safe method, and a more effective therapeutic procedure than the traditional three-nerve targeted technique for chronic knee OA. US National Library of Medicine https://clinicaltrials.gov/ct2/show/NCT05073887?term=Selin+Guven+kose&draw=4&rank=5.