Genicular Nerve Research Articles

Radiofrequency of the genicular nerves as a way to postpone knee arthroplasty. Case reports

Radiofrequency of the genicular nerves as a way to postpone knee arthroplasty. Case reports

Pain management in patients with knee osteoarthritis by ultrasound-guided genicular nerve block. Case reports

ABSTRACT BACKGROUND AND OBJECTIVES: Knee osteoarthritis is a chronic disease that tends to affect elderly people and is characterized by severe pain, joint stiffness and limited function. In more advanced cases, the initial approach of knee osteoarthritis performed with traditional conservative pharmacological or non-pharmacological treatment may not present satisfactory results. There are alternatives for pain intervention with favorable results, with longer analgesia and that can help rehabilitation, such as analgesic peripheral nerve blocks, including the genicular nerve block, and radiofrequency ablation. The objective of this study is to report cases of genicular nerve block guided by ultrasonography, with favorable results in relation to analgesia and return of functional capacity. CASE REPORTS: Four elderly patients diagnosed with advanced knee osteoarthritis, with limited range of motion, and with severe chronic pain (mean visual numeric scale - VNS=7.75) were submitted to ultrasound-guided genicular nerve block, presenting significant pain improvement (mean VNS after 1 month of block=2.25) and regain of functional capacity. There were no cases of complications. CONCLUSION: Genicular nerve block guided by ultrasonography is a technique that can be performed as an intervention measure in pain. It presents satisfactory results of analgesia and regain of functional capacity, facilitating the rehabilitation process, and can be adopted in an outpatient clinic context.

A study of outcome of thermal radiofrequency nerve ablation of genicular nerves for the management of chronic osteoarthritis of knee joint

A study of outcome of thermal radiofrequency nerve ablation of genicular nerves for the management of chronic osteoarthritis of knee joint

The comparison of efficacy of single intraarticular steroid injection versus the combination of genicular nerve block and intraarticular steroid injection in patients with knee osteoarthritis: a randomised study.

The aim of this study is to evaluate the efficacy of genicular nerve block (GNB) and intraarticular corticosteroid injection (IACSI) in patients with knee osteoarthritis (OA). Forty patients with Kellgren-Lawrence grade 2-4 knee OA were included for the study. Patients were divided into two groups randomly as IACS and IACS + GNB groups. All patients were evaluated with ultrasound for cartilage thickness, patellar tendon thickness, quadriceps tendon thickness and quadriceps muscle cross-sectional area (QMA). Pain intensity of the patients was evaluated with visual analogue scale and the Leeds Assessment of Neuropathic Symptoms and Signs pain scale. Functional status of the patients was evaluated with Western Ontario and Mc Master Universities Osteoarthritis Index. Quality of life of the patients was assessed with Nottingham Health Profile (NHP). All assessments were measured and compared at baseline, 1st month and 3rd month after treatment. All evaluation parameters were significantly improved in IACSI and IACSI + GNB groups. However, the improvement was better in IACSI + GNB group compared to those in IACSI group in terms of all evaluation parameters except QMA (0.10 ± 0.18 and 0.11 ± 0.22, respectively) and NHP scores in 1st month evaluation (- 3.11 ± 6.99 and - 3.54 ± 1.74, respectively). When combined with IACSI, GNB yields better analgesic effect and improves function in patients with knee OA compared to only IACSI.

Role of ultrasound in diagnostic genicular nerve block for knee osteoarthritis pain

Role of ultrasound in diagnostic genicular nerve block for knee osteoarthritis pain - IJCA- Print ISSN No: - 2394-4781 Online ISSN No:- 2394-4994 Article DOI No:- 10.18231/j.ijca.2019.110, Indian Journal of Clinical Anaesthesia-Indian J Clin Anaesth

Cooled Radiofrequency Ablation Treatment of the Genicular Nerves in the Treatment of Osteoarthritic Knee Pain: 18- and 24-Month Results.

ObjectiveThe primary objective of this observational, prospective, multicenter study was to evaluate the long‐term outcomes, including pain, function, and perceived effect of treatment, in subjects undergoing cooled radiofrequency ablation (CRFA) who have pain due to osteoarthritis (OA) of the knee.MethodsThis analysis included a subset of subjects previously enrolled in a prospective, multicenter randomized study comparing the safety and effectiveness of CRFA and intra‐articular steroid injection in patients with knee OA through 12 months who were contacted to participate in this extension study. Subjects were enrolled if they agreed to participate in up to 2 additional follow‐ups, at 18 and 24 months.ResultsEighty‐three subjects from the 5 participating sites underwent CRFA during the original study and were contacted for this extension study. Of the 33 subjects enrolled, 25 were evaluated at 18 months after CRFA treatment, and their mean numeric rating scale (NRS) score was 3.1 ± 2.7, with 12 subjects reporting ≥50% pain relief compared to baseline. At 24 months, 18 subjects reported a mean NRS score of 3.6 ± 2.8, with 11 demonstrating ≥50% pain relief. Functional improvement as measured by the Oxford Knee Score continued to be present, with an overall mean change from baseline of 26.0 ± 9.6 points at 18 months and 29.9 ± 10.4 points at 24 months.ConclusionIn this subset of subjects from a randomized controlled trial, CRFA provided sustained pain relief, improved function, and perceived positive effect through 24 months for subjects with OA knee pain with no safety concerns identified.

Infiltration Between the Popliteal Artery and Capsule of the Knee (iPACK): Essential Anatomy, Technique, and Literature Review

In this review, we discuss the essential iPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) anatomy, block technique as well as potential complications, contraindications, and relevant literature evaluating the efficacy of the iPACK block. Recent literature supports the efficacy of the iPACK in controlling pain, improving postoperative physical therapy performance, and decreasing hospital length of stay (LOS). Cadaver studies have demonstrated that injection of dye in the tissue plane between the popliteal artery and the femoral shaft cranial to femoral condyles spreads to the genicular nerves that innervate the posterior knee and forms the basis of the analgesic mechanism of the iPACK. Randomized controlled trials have shown that the iPACK, when used in combination with a femoral nerve block (FNB) or adductor canal block (ACB), is superior to a FNB or ACB alone in controlling postoperative pain. The iPACK controls posterior knee pain following total knee arthroplasty (TKA) by anesthetizing the articular branches from the sciatic and obturator nerves. This is a safe and relatively simple block to perform with a low risk of serious complications.

Investigation of genicular neurotomy of the knee: MRI characterization of anatomy and implications for intervention

BackgroundGenicular nerve block and subsequent radiofrequency neurotomy (RFN) has emerged as a novel intervention and alternative for total knee arthroplasty in patients with refractory pain from knee osteoarthritis (OA). To our knowledge, there is no cited report correlating the accuracy of localizing the genicular nerves using bony landmarks on magnetic resonance imaging (MRI). ObjectivesTo quantify the proximity of superomedial genicular nerve (SMGN), superolateral genicular nerve (SLGN), and inferomedial genicular nerve (IMGN) from a target point. The target point was an intersection marked by a line parallel to the diaphysis and a separate line parallel to the metaphyseal flare along the cortical surfaces of both the femur and tibia. DesignRetrospective chart review. PatientsA total of 25 de-identified knee MRIs were reviewed. MethodsThe coronal proton density fat suppressed sequence was used for identification and localization of the SLGN, SMGN, and IMGN. The neurovascular bundles were traced from posterior location along their origin as they wrap around the distal diaphysis. The nerve locations were determined by consensus measurements performed by two board-certified radiologists with certificates of added qualification in neuroradiology and interventional radiology. The proximity of each respective genicular nerves was measured by drawing a perpendicular line from each genicular nerve to the height of the target point. All measurements were taken on the mid-coronal view at the point of maximal epiphyseal flare. Main outcome measurementsPositive values indicated the location of the neurovascular bundle to be superior to the target point. Negative values indicated the location of the neurovascular bundle to be inferior to the target point. ResultsThe distance between our target point and the inferior border of SLGN ranged from −3 mm to 6 mm. Twenty-three out of 25 (92%) SLGN lied exactly at or above our target intersection. The distance between our target point and the inferior border of SMGN ranged from −1 mm to 2 mm with twenty-two out of 25 (88%) SMGN lied exactly at or above our target point. The distance between our target point and the superior border of IMGN ranged from 0 mm to 3 mm with all (100%) IMGN lying exactly at or above the target point. ConclusionThe intersection of the femoral diaphyseal shaft to a line along the metaphyseal flare and the intersection of the tibial diaphyseal shaft to a line along the medial metaphyseal can be used as a target point to localize the genicular nerves with close proximity.

Conventional Thermal versus Water-Cooled Genicular Nerve Radiofrequency Lesioning: A Retrospective Chart Review

Background: Genicular nerve radiofrequency lesioning (RFL) is an interventional approach to chronic knee pain. It is currently unknown whether conventional thermal RFL (CT-RFL) or watercooled RFL (WC-RFL) yields better outcomes. Objective: The objective of this research was to analyze and compare outcomes of genicular nerve conventional thermal radiofrequency lesioning (CT-RFL) vs water-cooled radiofrequency lesioning (WC-RFL) for the treatment of chronic knee pain. Study Design: We used retrospective chart review. Setting: The research took place in an outpatient pain clinic at a large academic medical center. Methods: Patients who participated in the study were those aged 18 and older who received genicular nerve RFL for chronic knee pain between January 1, 2014 and December 31, 2016. Random intercepts models were used to examine Visual Analog Scale (VAS) pain scores across the first year of follow-up, adjusting for age, gender, and prior history of knee surgery. Results: Overall, VAS scores were significantly reduced from baseline (mean = 6.66, standard deviation [SD] = 1.36) by 1.46 points during the first follow-up month (95% confidence interval [CI], 0.6-2.3, P = .001), 2.22 points during the second follow-up month (95% CI, 1.4-3.1, P = < .001), and 1.24 points during the sixth follow-up month (95% CI, 0.1-2.4, P = .035) but were not significantly reduced at other months during the one-year followup time period. There was no statistically significant difference in follow-up pain scores (mean difference = 0.73, 95% CI, -0.14-1.59, P = .116) or rates of complications (P = .10, 2-tailed Fisher exact test) between RFL types. Limitations: Study shortcomings include patient loss to follow-up, heterogeneity of CT-RFL techniques, and heterogeneity of study patients. Conclusions: Genicular RFL is a promising strategy for long-term management of treatment-resistant chronic knee pain. In this study, no significant difference in outcomes was detected between CT-RFL and WC-RFL techniques. Larger prospective studies are warranted to compare outcomes of these techniques and guide future care. Key words: Radiofrequency lesioning, knee pain, chronic pain, osteoarthritis, genicular, cooled radiofrequency lesioning, water-cooled radiofrequency lesioning, conventional radiofrequency lesioning

Ultrasound-guided Monopolar Versus Bipolar Radiofrequency Ablation for Genicular Nerves in Chronic Knee Osteoarthritis

Ultrasound-guided Monopolar Versus Bipolar Radiofrequency Ablation for Genicular Nerves in Chronic Knee Osteoarthritis

Efficacy of Genicular Nerve Radiofrequency

Efficacy of Genicular Nerve Radiofrequency

Feasibility of an ultrasound-guided approach to radiofrequency ablation of the superolateral, superomedial and inferomedial genicular nerves: a cadaveric study

IntroductionGenicular nerve radiofrequency (RF)denervation appears to be a promising treatment for knee pain in patients with degenerative osteoarthritis of the knee, when candidates are not suitable for arthroplasty. This study...

Accuracy of fluoroscopic-guided genicular nerve blockade: a need for revisiting anatomical landmarks

Background and objectivesGenicular nerve blockade (GNB) and radiofrequency ablation (RFA) have recently emerged as treatment options for patients with chronic knee pain. However, an increasing number of anatomical studies and...

The Effectiveness and Safety of Genicular Nerve Radiofrequency Ablation for the Treatment of Recalcitrant Knee Pain Due to Osteoarthritis: a Comprehensive Literature Review

Review the effectiveness and safety of current treatment protocols for fluoroscopically guided genicular nerve radiofrequency ablation (RFA) used for recalcitrant knee pain secondary to osteoarthritis (OA). Randomized controlled trials and cohort studies of fluoroscopically guided RFA of the genicular nerves demonstrate variability in responder rates from 59% at 3 months to as high as 74% at 6 month follow-up. Studies that investigated the prognostic value of genicular nerve blocks to select patients for RFA demonstrate no difference in outcomes with current treatment protocols. Other factors that may influence the success rate of this procedure include radiologic severity of osteoarthritis, longer duration of knee pain, smoking, and bilateral knee pain. Relative safety of this procedure has been shown with no adverse events reported in reviewed trials, but several case reports demonstrate there are risks associated with this procedure. Recent neuroanatomical studies show additional genicular nerves that could likely be safely targeted by RFA, yet are not included in current treatment protocols. RFA provides an effective treatment option for patients with recalcitrant chronic knee pain secondary to OA with up to 74% of patients experiencing greater than 50% pain relief at 6 months. The procedure is relatively safe, but risks should be weighed against potential benefits. Further research is needed to determine need for prognostic blocks, determine prognostic radiologic factors, and determine changes in effectiveness with updated treatment protocols that target more genicular nerves.

High Frequency Intensive Autologous PRP Injection and Genicular Nerve Blocks in Treating Knee Osteoarthritis

High Frequency Intensive Autologous PRP Injection and Genicular Nerve Blocks in Treating Knee Osteoarthritis

Genicular nerve ablation: a systematic review of procedure outcomes for chronic knee pain

Background: Chronic pain caused by knee osteoarthritis is becoming more common among the elderly. Furthermore, patients who would otherwise benefit from total joint arthroplasty are not candidates for surgery due to increasingly high rates of obesity and diabetes. Genicular nerve ablation has become an attractive alternative to arthroplasty in these patients. This systematic review sought to assess the effectiveness and safety of genicular nerve ablation. Methods: A literature search of PubMed, Medline, clinicaltrials.gov, and Google Scholar was conducted for studies performing genicular nerve ablation with radiofrequency. Clinical and patient-centric outcomes were obtained. Results: Eleven studies and 194 knees were included in this analysis. Our review revealed that visual analog pain scores decreased from an average score of 8/10 to 1.9/10, 2.3/10, 2/10, and 4/10 at 3, 6, and 12 mo after genicular ablation, respectively. Additionally, Oxford Knee Scores and scores on the Western Ontario and McMaster Universities Arthritis Index showed improvements that were sustained at least up to 12 wk and 1 yr, respectively. There were very few procedural complications. Conclusions: Genicular nerve ablation with radiofrequency has demonstrated favorable outcomes with low complication rates.

Distribution of sensory nerves supplying the knee joint capsule and implications for genicular blockade and radiofrequency ablation: an anatomical study

Despite their emerging therapeutic relevance, there are many discrepancies in anatomical description and terminology of the articular nerves supplying the human knee capsule. This cadaveric study aimed to determine their origin, trajectory, relationship and landmarks for therapeutic purpose. We dissected 21 lower limbs from 21 cadavers, to investigate the anatomical distribution of all the articular nerves supplying the knee joint capsule. We identified constant genicular nerves according to their anatomical landmarks at their entering point to knee capsule and inserted Kirschner wires through the nerves in underlying bone at those target points. Measurements were taken, and both antero-posterior and lateral radiographs were obtained. The nerve to vastus medialis, saphenous nerve, anterior branch of obturator nerve and a branch from sciatic nerve provide substantial innervation to the medial knee capsule and retinaculum. The sciatic nerve and the nerve to the vastus lateralis supply sensory innervation to the supero-lateral aspect of the knee joint while the fibular nerve supplies its infero-lateral quadrant. Tibial nerve and posterior branch of obturator nerve supply posterior aspect of knee capsule. According to our findings, five constant genicular nerves with accurate landmarks could be targeted for therapeutic purpose. The pattern of distribution of sensitive nerves supplying the knee joint capsule allows accurate and safe targeting of five constant genicular nerves for therapeutic purpose. This study provides robust anatomical foundations for genicular nerve blockade and radiofrequency ablation.

Ultrasound-guided Genicular Nerve Block for Total Knee Arthroplasty (GenTKR)

Ultrasound-guided Genicular Nerve Block for Total Knee Arthroplasty (GenTKR)

Alcohol neurolysis of genicular nerve for chronic knee pain.

Radiofrequency neurolysis (RFN) of the genicular nerves has recently become accepted as an effective technique to alleviate knee pain particularly in patients with knee osteoarthritis (OA) or postoperative pain. However, genicular nerve RFN can produce high procedure and equipment costs, longer procedural times, procedure-related pain, and failure rate of over 25%. We are presenting two cases of alcohol neurolysis of the genicular nerve using fluoroscopy and ultrasonography in patients with knee OA or persistent postsurgical pain of the knee. Alcohol neurolysis of the genicular nerve with dual imaging modality can be a cheap, safe and effective method in patients with chronic knee pain.

COMMON PERONEAL NERVE PALSY AND LONG-LASTING ROPIVACAINE DURATION AFTER INFEROLATERAL GENICULAR NERVE BLOCK: A CASE REPORT

This case report introduces a 43-year-old woman who presented with left knee pain due to knee osteoarthritis. She developed a long-lasting nerve block with ropivacaine, plus common peroneal nerve palsy and foot drop following a genicular nerve block. Key words: Ropivacaine, knee osteoarthritis, genicular nerve block, foot drop