Genicular Nerve Research Articles

Efficacy and Safety of Ultrasound-Guided Radiofrequency Treatment for Chronic Pain in Patients with Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

Background Knee osteoarthritis (KOA) is a common degenerative disease associated with joint dysfunction and pain. Ultrasound-guided radiofrequency (RF) may be a promising therapy in the treatment of chronic pain for KOA patients. Objective To evaluate the efficacy and safety of ultrasound-guided RF treatment for chronic pain in patients with KOA. Design A systematic review was conducted, and a meta-analysis was carried out when possible. Setting. We examined the studies evaluating the clinical efficiency of ultrasound-guided RF on chronic pain in KOA population. Method A systematic review for the efficacy and safety of ultrasound-guided RF treatment for pain management of KOA patients was carried out in PubMed, EMBASE, Cochrane Library, Web of Science, Wanfang Data, and China National Knowledge Infrastructure (CNKI) from the date of inception to February 2020, and a meta-analysis was conducted. The primary outcomes of pain intensity (visual analogue scale or numerical rating scale) and knee function [the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)] were evaluated from baseline to various follow-up times by random-effects model. Heterogeneity was assessed by I2 statistic and the potential sources of heterogeneity by subgroup and metaregression analyses, respectively. Results Eight publications with 256 patients were included in the meta-analysis. RF could relieve pain with −4.196 of pooled mean difference and improve knee function by decreasing 23.155 points in WOMAC. Three patients had ecchymosis, two with hypoesthesia and one with numbness after the procedure, and improved within 6 months. Furthermore, study design and treatment target were the sources of heterogeneity by subgroup and metaregression analyses, accounting for 37% and 74% of variances, respectively. Target of genicular nerve achieved better pain relief than intra-articular or sciatic nerve. Sensitivity analysis showed that removal of any single study was unlikely to overturn the findings. Limitations. There were some limitations in the study. Firstly, the small number of relevant studies limited the confidence level of the meta-analysis. Also, the significant heterogeneity may not be explained due to the limited data. Secondly, the direct comparison of two different guidance methods (ultrasound vs. fluoroscopy) for RF therapy is lacking. In addition, the outcomes were blindly assessed in the meta-analysis from all studies according to evaluation of bias, which could affect the reality of the data. Finally, most of the studies only provided short follow-up times, so we could not analyze the long-term effectiveness of ultrasound-guided RF in the treatment of patients with KOA. Conclusions Ultrasonography is an effective, safe, nonradiative, and easily applicable guidance method for RF in pain relief and functional improvement in KOA patients.

An anatomical neurovascular study for procedures targeting peri-articular nerves in patients with anterior knee pain

BackgroundRadiofrequency ablation (RFA) of the articular branches innervating the anterior knee capsule has been studied as a possible alternative to surgery for degenerative arthritis. However, the neurovascular topography of the anterior knee capsule remains unclear. MethodsOne leg from each of the 20 formalin-embalmed cadaveric specimens was investigated. Modified ablation points (MAPs) were evaluated for a possible alternative for conventional target points (CAPs). ResultsFor the nerve to vastus medialis (NVM), the probability of identifying the nerve was higher at MAP compared with CAP (62.5% vs. 25%). The mean shortest distance from the nerve was shorter at MAP compared with CAP (18.0 mm vs. 29.9 mm). The probabilities and distances for other nerves were not significantly different between the points. However, the probability of identifying the artery was significantly lower at MAPs compared with CAPs for arteries (0%, 5.3%, and 0% vs. 84.2%, 84.2%, and 73.3% for superior medial genicular, superior lateral genicular, and inferior medial genicular artery, respectively). For the recurrent peroneal nerve (RPN), a new target point was set in MAPs. ConclusionsThe current landmark for genicular nerve procedures may not accurately target the correct nerve position, or reduce the risk for vessel damage. A more proximal target may reduce complications and increase the probability of successful procedures, although clinical correlation is needed.

Can the addition of ultrasound-guided genicular nerve block using 5% dextrose water augment the effect of autologous platelet rich plasma in treating elderly patients with knee osteoarthritis?

BackgroundTo investigate whether the addition of injecting 5% dextrose water to the genicular nerves can augment the effect of platelet rich plasma (PRP) injections in treating elderly patients with moderate degree of knee osteoarthritis (OA). MethodsForty-six elderly patients with grade 3 on the Kellgren and Lawrence knee OA grading system were divided into control and genicular nerve block groups. Both groups received 4 milliliters (mL) of PRP injected into the knee joint and 2 mL of PRP to the pes anserinus complex. In the nerve block group, 2 mL of 5% dextrose water was also injected to each genicular nerve. In the control group, normal saline was used to inject the genicular nerves. Proteomic technique of 2-dimensional electrophoresis was used to detect the changes in synovial fluid (SF) protein concentrations. Lequesne Functional Index was used to evaluate knee functional status. ResultsAfter 3 monthly PRP injections, concentrations of SF total protein, and proteins associated with inflammation decreased. Protein concentrations associated with chelation increased. In the nerve block group, improvements in pain and in the functional status of the knee joint lasted up to a period of 6 months. At 1 month and 3 months after the injections, Lequesne Functional Index was less than 7 (a value of 7 or higher indicates knee OA). ConclusionThe concept of combining 5% dextrose water injection to the genicular nerves, and PRP injection into the knee joint and to the pes anserinus complex can be a feasible non-operative conservative treatment option for elderly patients with knee OA.

Effectiveness of Genicular Nerve Radiofrequency Ablation: A Case Series and Considerations for Future Research

Background: Postherpetic neuralgia (PHN) is the most common complication of shingles and can be a significant burden to patients due to pain and disability. Currently, treatment options are limited. In refractory cases, neuromodulation using spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) have been used but is considered experimental due to limited evidence. Case Report: We report 2 cases who experienced successful treatment of refractory PHN. Patients underwent dorsal root ganglion (DRG) stimulation at the thoracic level for the treatment of refractory PHN. Conclusion: Both patients showed significant improvement in pain at 24 and 36 months after a DRG stimulation trial and implantation. We report the successful use of DRG stimulation for the treatment of PHN. Key words: Knee, genicular, radiofrequency ablation, osteoarthritis, pain, block, cooled

175. Discrepancy in patient-reported pain using the numeric pain scale and a percentage change to quantify treatment effectiveness after pain injections

BACKGROUND CONTEXT The Numeric Pain Rating Scale (NRPS) may not match with patient-reported percentage pain reduction (PRPPP) at 1 to 4 weeks follow-up, as these patients may be reporting a higher estimated percentage improvement compared to the value calculated from their pain scores PURPOSE The objective of this study was to calculate patients’ pain level prior to and after various fluoroscopic injections using the NRPS. The calculated percent change was then compared to a patient-reported percent change. Our hypothesis was that there is a statistically significant difference in calculated NRPS vs patient-reported percentage change. The discrepancy between calculated percent change compared to the patient reported percent change was studied since accurately assessing patient reported pain impacts clinical management of patients with chronic musculoskeletal pain STUDY DESIGN/SETTING This is a retrospective study using patient reported pre- and postinjection NRPS value were used to calculate a percent change in overall pain ([pre-post)/post] x 100). The calculated percent change was rounded to the nearest degree. This calculated percent change in pain was compared to the patient reported percent change (calculated % - reported %). An overall average change in calculated minus reported percent change was obtained for all the injections. A t-test was also performed to determine if there was a significant difference between the calculated percent change and the reported percent change. PATIENT SAMPLE A total of 135 patients were included. OUTCOME MEASURES The patient reported pre- and postinjection NRPS value were used to calculate a percent change in overall pain ([pre-post)/post] x 100). This calculated percent change in pain was compared to the patient reported percent change (calculated % - reported %). METHODS A total of 135 patients who underwent spinal corticosteroid injections under fluoroscopic-guidance between 2015 and 2017 were retrospectively reviewed. The patient reported pre- and postinjection NRPS value were used to calculate a percent change in overall pain ([pre-post)/post] x 100). This calculated percent change in pain was compared to the patient reported percent change (calculated % - reported %). An overall average change in calculated minus reported percent change was obtained for all the injections. Univariate analysis was utilized to compare the calculated percent change and the reported percent change. RESULTS Data from 135 patient charts was analyzed with a total of 144 injections. This study included 36 males and 99 females. The average patient age was 63.0 years. A total of 42 patients had a BMI >30 and 7 patients had a prior surgical history in the same joint which was injected. Various injections included sacroiliac joint (SI J, n=15), medial branch blocks (MBB, n=21), lumbar transforaminal epidural steroid injections (LTFESI, n=65), lumbar and cervical epidural steroid injections (LESI and CESI, n=25), radiofrequency ablations (RFA), genicular nerve block of the knee, and various shoulder joint injections. The average difference in calculated percent change vs the patient-reported percent change in pain prior to and after the injections was -18.37% (p CONCLUSIONS Effective management of chronic musculoskeletal pain is important due to its physical, social, and financial burden on patients and the healthcare system. Management of chronic pain is heavily impacted by the meaningful use of various patient reported outcome measures. Health insurance companies use variable percent change in pain level to determine effectiveness of treatment. Our data reflects the existence of a statistically significant difference between calculated percent change in pain using the NRPS as compared to patient reported percent change. Based on this analysis it may be valuable to use other functional and psychosocial outcome measures for chronic pain management. Further studies are needed to assess the combined use of the different outcome measures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Comparing the Safety and Effectiveness of Radiofrequency Thermocoagulation on Genicular Nerve, Intraarticular Pulsed Radiofrequency with Steroid Injection in the Pain Management of Knee Osteoarthritis

Background: Knee osteoarthritis (KOA) is characterized by the clinical symptoms of chronic knee pain and knee dysfunction, leading to disability and influencing the quality of life in severe cases. Radiofrequency treatment is a new method to reduce KOA-related pain and partially improve knee joint dysfunction without adverse effect. Objective: The present study aimed to assess the treatment efficacy of radiofrequency thermocoagulation on the genicular nerve (RFTGN) and intraarticular pulsed radiofrequency (IAPRF) for KOA. Study Design: Retrospective comparative study design. Setting: This study took place at Shengjing Hospital of China Medical University. Method: KOA patients were randomly assigned to the RFTGN, IAPRF, and intraarticular steroid injection (IAS) groups. All procedures were performed under the guidance of computed tomography (CT). The observation indicators of this study were the numeric rating scale (NRS), Oxford knee scale (OKS), and perceived global effect (GPE). The time points for the assessment were 1-week, 1-month, 3-months, and 6-months after the treatment. Results: The postoperative NRS scores in the 3 groups decreased significantly at all the observation time points as compared to the pretreatment scores (P < 0.05). For the patients in the IAS group, the analgesic effect was in a rebound trend, which was the best at 1-week posttreatment, and was close to the preoperative level at 6-months posttreatment. The short-term (1 week or 1 month) analgesic effect of the RFTGN group was better than that of the IAPRF group, and was similar in the long-term (3 or 6 months). The long-term analgesic effect of RFTGN and IAPRF groups was better than that of IAS group. The results of the OKS score were similar to the NRS score. The RFTGN group showed markedly improved knee function in the long-term than the IAPRF and IAS groups. The short-term treatment satisfaction was similar in each group, and some differences were detected between the groups with respect to long-term treatment satisfaction. Limitation: This study was a single-center retrospective study with a relatively small sample cohort and short follow-up period Conclusion: Both RFTGN and IAPRF could alleviate the knee joint pain and improve the knee joint dysfunction; however, the treatment efficacy of RFTGN was better than that of IAPRF. Key words: radiofrequency thermocoagulation, genicular nerve, pulsed radiofrequency, knee osteoarthritis, knee pain, intraarticular, steroid

Current versus revised anatomical targets for genicular nerve blockade and radiofrequency ablation: evidence from a cadaveric model

IntroductionRecent studies have proposed revised anatomical targets to improve accuracy of genicular nerve (GN) radiofrequency ablation (RFA). This study aims to compare the accuracy of classical and revised techniques for...

Comparing the effectiveness of ultrasound guided versus blind genicular nerve block on pain, muscle strength with isokinetic device, physical function and quality of life in chronic knee osteoarthritis: a prospective randomized controlled study.

BackgroundThe genicular nerve block (GNB) is demonstrated from several reports to alleviate pain and improve knee functionality in patients with chronic knee osteoarthritis (OA). Ultrasound (US)-guided GNB has been the most used imaging method. This study aimed to compare the effectiveness of US-guided versus blind GNB in the treatment of knee OA.MethodsThis prospective, randomized clinical trial included patients with knee OA based on American College of Rheumatology diagnostic criteria. The patients were evaluated for clinical and dynamometer parameters at the baseline, 4 weeks after treatment, and 12 weeks after treatment. The patients underwent blind injection or US-guided injection.ResultsWhen compared with the baseline, both groups showed significant improvement in pain, physical function, and quality of life parameters. Significant differences were observed between the groups for clinical parameters (30-second chair stand test, 6-minute walk test) in favor of the US-guided group. On the other hand, blind injection was more significantly effective on some parameters of the Nottingham Health Profile. There wasn’t any significant improvement in isokinetic muscle strength for either group.ConclusionsThis study demonstrated that both US-guided and blind GNB, in the treatment of knee OA, were effective in reducing symptoms and improving physical function. GNB wasn’t an effective treatment for isokinetic muscle function. US-guided injections may yield more effective clinical results than blind injections.

Genicular Nerve Pulsed Dose Radiofrequency (PDRF) Compared to Intra-Articular and Genicular Nerve PDRF in Knee Osteoarthritis Pain: A Propensity Score-Matched Analysis.

BackgroundChronic knee osteoarthritic (OA) pain is a common and debilitating complaint in elderly patients. Despite numerous pharmaceutical options, the majority of patients still experience long-term pain. Genicular nerve (GN) radiofrequency has become increasingly popular as a treatment for knee pain. This retrospective study aimed to evaluate the effects of pulse dose radiofrequency (PDRF) in patients with chronic knee OA pain.Patients and MethodsPropensity score matching analysis was performed in a retrospective cohort of 78 patients with moderate-severe knee OA pain unresponsive to conservative treatment who underwent PDRF GN or intra-articular (IA) and PDRF GN. Pain relief was measured using the numeric rating scale (NRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Patient Global Impression of Change (PGIC) at 3 and 6 months post-intervention.ResultsA significant reduction in NRS scores was reported at 3 (p<0.001) and 6 months (p<0.001) after PDRF in both groups. NRS was lower in PDRF IA + GN than PDRF GN (p<0.0001). WOMAC pain was significantly reduced at 3 months in PDRF IA + GN group (baseline: 10.12±3.14, 3 months: 6.25±2.44, p=0.0001). WOMAC stiffness and function were improved only at 3 months in PDRF IA + GN compared to baseline (p=0.007 and p=0.006, respectively). A longer period of pain relief was reported after PDRF IA + GN (6.75±2.42 months) compared to PDRF GN (4.31±2.85 months, p<0.001) in association with higher PGIC scores.ConclusionThis is the first study that compared two different PDRF techniques. PDRF GN and PDRF IA + GN were both effective in reducing pain at 3 and 6 months follow-up. However, only PDRF IA + GN was able to improve WOMAC scores at 3 months after the treatment with a longer period of efficacy compared to PDRF GN alone.

THE COMPARISON BETWEEN TWO METHODS FOR THE RELIEF OF KNEE OSTEOARTHRITIS PAIN USING OXFORD KNEE SCORE (IMPROVEMENT CHANGES AFTER 4 WEEK FOLLOW UP INJECTION) : INTRAARTICULAR AND GENICULAR NERVE BLOCK IN BLAMBANGAN GENERAL DISTRICT HOSPITAL BANYUWANGI

Pain is the hallmark symptom of OA. IACI can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with knee OA. Recent study reported successful pain relief by ablation of the three branches of the Genicular nerve [superior lateral (SL), superior medial (SM), and inferior medial (IM). In the ultrasound-guided GNB technique, these three nerves were selected for the same reasons. Previous studies have identified OKS thresholds to aid the clinician in presenting the expected outcome of surgery in a meaningful way to the patient (OKS provides a means of comparing preoperative and post-operative health status).This cross-sectional, respondents were filled OKS questionaire, and they were self-reported a diagnosis of OA at least one knee by a physician, reported more than 3 months of persistent OA pain. These data were collected at the first post-injection (IACI &GNB) and at 4 week followup visit. The analysis was performed by Independent T-test in SPSS version 22. In IACI group the mean of initial OKS was 37,81±6,87 compare to 34,94±6.14 in GNB group. After 4 weeks, it increased to 42±7.14 and 42,84±7,67 respectively. A total of 82 patients were randomized, with patients receiving an injection, 32 receiving IAIC injection and 50 receiving GNB injection. From Independent Samples T Test, GNB injection demonstrated significantly greater pain reductions and greater percent OKS score improvement than IACI up to 4 weeks postinjection. Comparing two methods, there were significant difference between two groups based on OKS: p=0.000

Genicular nerve radiofrequency ablation as an alternative to total knee arthroplasty in patients being followed in a non-operative multidisciplinary knee osteoarthritis clinic

Purpose: The purpose of our study was twofold. First, to evaluate the efficacy of Genicular Nerve Block (GNB) and Radiofrequency Ablation (RFA) in non-surgical candidates being followed in a multidisciplinary non-operative knee Osteoarthritis clinic. Second, to identify osteoarthritis functional measures and patient factors predicting treatment outcomes from these procedures. This study explores a multidisciplinary approach to the management of knee OA, where patients receive instruction from physical therapy, nutrition, and medical intervention all during the same visit in our multidisciplinary knee OA clinic.

Bilateral Genicular Nerve Radio Frequency Ablation (RFA) For The Treatment Of Refractory Pain In A Patient With Pigmented Villonodular Synovitis (PVNS)

Bilateral Genicular Nerve Radio Frequency Ablation (RFA) For The Treatment Of Refractory Pain In A Patient With Pigmented Villonodular Synovitis (PVNS)

Periarticular needle-based therapies can cause periprosthetic knee infections

Periarticular needle-based therapies such as dry needling, acupuncture, and genicular nerve radiofrequency ablation are becoming more popular for treatment of knee osteoarthritis. These therapies are also being used after total knee arthroplasty for persistent postoperative pain. Although limited published evidence exists for the risk of periprosthetic joint infection after these procedures, we describe one case of periprosthetic joint infection developing shortly after dry needling and another case developing shortly after genicular nerve blocks. We present details of these 2 cases along with a review of the literature regarding the use of periarticular needle-based therapies after total knee arthroplasty.

Ultrasound-guided cooled radiofrequency ablation of the genicular nerves: a technique paper.

Aim: Cooled radiofrequency ablation (CRFA) has demonstrated efficacy in the management of knee pain caused by osteoarthritis. A typical procedure involves fluoroscopic placement of internally cooled radiofrequency probes to ensure the probes are located near target genicular nerves. Patients & methods: A new technique was developed to perform CRFA using ultrasound (US) guidance. Patient outcomes were reported using a telephone survey. Results: Ablation procedures were successfully performed using US guidance. A total of 51 patients were retrospectively identified for telephone screening. A total of 22 patients completed the telephone questionnaire. There were no safety concerns identified and the majority of patients reported satisfactory outcomes. Conclusion: Patient outcomes demonstrate that US-guided CRFA procedures provide pain relief and functional improvement. Further studies are needed to compare the efficacy of US-guided CRFA to fluoroscopy-guided CRFA procedures.

Procedural Treatments for Knee Osteoarthritis: A Review of Current Injectable Therapies

Knee osteoarthritis is a common painful degenerative condition affecting the aging Canadian population. In addition to pain and disability, osteoarthritis is associated with depression, comorbid conditions such as diabetes, and increased caregiver burden. It is predicted to cost the Canadian healthcare system $7.6 billion dollars by 2031. Despite its high cost and prevalence, controversy persists in the medical community regarding optimal therapies to treat knee osteoarthritis. A variety of medications like nonsteroidal anti-inflammatories and opioids can cause severe side effects with limited benefits. Total knee arthroplasty, although a definitive management, comes with risk such as postoperative infections, revisions, and chronic pain. Newer injectable therapies are gaining attention as alternatives to medications because of a safer side effect profile and are much less invasive than a joint replacement. Platelet-rich plasma is beginning to replace the more common injectable therapies of intra-articular corticosteroids and hyaluronic acid, but larger trials are needed to confirm this effect. Small studies have examined prolotherapy and stem cell therapy and demonstrate some benefits. Trials involving genicular nerve block procedures have been successful. As treatments evolve, injectable therapies may offer a safe and effective pathway for patients suffering from knee osteoarthritis.

Patients With Chronic Knee Pain Treated With Conventional Radiofrequency of the Genicular Nerves

Patients With Chronic Knee Pain Treated With Conventional Radiofrequency of the Genicular Nerves

Evaluation of the proximal adductor canal block injectate spread: a cadaveric study

Background and objectivesQuadriceps sparing adductor canal block has emerged as a viable intervention to manage pain after total knee arthroplasty. Recent studies have defined ultrasound (US) landmarks to localize the...

Comparative study between intra-articular injections of hyaluronic acid with platelet-rich plasma versus genicular nerve thermal radiation in management of pain in knee osteoarthritis

ABSTRACT Background There are many factors affecting knee osteoarthritis (OA) as genetic and metabolic factors, obesity, mechanical trauma, osteoporosis, inflammatory joint disorders, previous joint infection, and laxity of ligaments. Objectives The aim of this study was to detect the influence of intra-articular injection (IAI) of both hyaluronic acid (HA) with platelet-rich plasma (PRP) and radiofrequency (RF) of genicular nerve and to compare their effects in the treatment of knee OA pain. Subjects and methods After approval of local research committee of anesthesia, Tanta University (committee protocol code 32049/01/18) and written informed consent, this prospective randomized study was done at Tanta University Hospital on 100 patients complaining of knees OA with mild-to-moderate degrees. IAI was performed in a pain clinic and RF was performed in an operating room during the period from April 2018 to January 2019. Results In intra-articular knee injection group, results show decreased visual analog scale (VAS) score from (3–10) at 1-week follow-up session to (0–8) in 6-month follow-up session. It also shows reduction of analgesia requirements (etoricoxib 60 and 90 mg) from (60–270) to (0–180) mg/day. In RF group patients, results show decreased VAS score from (0–9) at 1-week follow-up session to (0–5) in 6-month follow-up session. It also shows reduction of analgesia requirements (etoricoxib 60 and 90 mg) from (0–270) to (0–90) mg/day. Conclusion Both IAI of PRP with HA and RF of genicular nerves reduced pain of knee OA and reduced analgesic requirements with rapid onset in RF group.

Results of genicular nerve ablation by radiofrequency in osteoarthritis-related chronic refractory knee pain

Background/aim The aim of this study was to investigate the medium- to long-term effects of radiofrequency (RF) ablation of genicular nerves for chronic refractory knee pain due to osteoarthritis (OA).Materials and methodsForty-eight patients who underwent RF ablation of the genicular nerves were evaluated retrospectively. The visual analogue scale (VAS) score, Western Ontario and McMaster universities osteoarthritis index (WOMAC index), opioid and nonsteroidal antiinflammatory drug (NSAID) use score, quality of life score, and treatment satisfaction score were examined at 1, 3, and 6 months after the procedure.ResultsThe mean VAS scores were significantly lower at the 1-, 3-, and 6-month evaluations compared with the preoperative values (P < 0.001). A significant decrease was observed in the WOMAC index compared with preoperative values (P < 0.001). It was found that 66.7% of opioid users and 56.3% of NSAID users stopped using medication. No serious complications were encountered during or after the procedure. Conclusion In chronic refractory knee pain due to OA, the application of RF ablation to the genicular nerve is an effective and safe treatment option in the medium to long term.

A study of effect and side effects of thermal radiofrequency nerve ablation of genicular nerves for the management of chronic osteoarthritis of knee joint

A study of effect and side effects of thermal radiofrequency nerve ablation of genicular nerves for the management of chronic osteoarthritis of knee joint