Treatment Of Chronic Knee Pain Research Articles

Peripheral Nerve Stimulation in Chronic Knee Pain: A Case Series.

Introduction Chronic knee pain is increasing in prevalence and is associated with substantial limitations in functional mobility. Peripheral nerve stimulation (PNS) has been increasingly used to treat various chronic pain conditions. However, there is a paucity of research exploring the potential therapeutic benefit of PNS for chronic knee pain. Methods This research is a retrospective case series of all patients who received PNS for the treatment of chronic knee pain performed at a single-center academic medical institution between March 2021 and June 2022. The primary outcome was percent pain reduction six months after implantation. Outcome data was obtained via chart review and phone calls to patients. Secondary outcomes included percent pain reduction two weeks and two months after implantation and adverse medical events related to the procedure and nerve stimulation. Results Fourteen individual patients received PNS for chronic knee pain during the study period. Three of these patients received bilateral PNS for a total of 17 cases. The mean percent pain reduction six months after implantation was 52% (SD=28.2) (N=12). A total of 75.0% of participants (9/12) reported≥50% reductions in pain six months after implantation. No adverse events were reported relating to the implantation procedure and/or nerve stimulation. Conclusion PNS is a safe and efficacious treatment modality for chronic knee pain with demonstrated long-term benefit. Further research should clarify patient factors associated with improved treatment response.

Peripheral nerve stimulation for the treatment of chronic knee pain

The average age of our population is increasing, resulting in a high incidence of chronic degenerative knee pathologies. Several treatment options, including surgical procedures are available to help mitigate these pathologies. However, the percentage of subjects with chronic post-surgical knee pain is still estimated at 16–20%. Neuromodulation techniques such as spinal cord stimulation and dorsal root ganglion stimulation (DRGS) are treatment options for subjects with chronic knee pain. The evidence for peripheral nerve stimulation (PNS) is minimal due to a limited number of neuromodulation systems capable of targeting the distal part of the lower limbs. This study aimed to investigate the safety and efficacy externally powered PNS systems for the treatment of chronic intractable knee pain targeting the saphenous nerve. Patients suffering from chronic intractable post-surgical knee pain received landmark-guided peripheral nerve stimulation of the branches of the saphenous nerve. All implants were performed with an externally powered PNS system to avoid lead migration as a result of cross-joint lead positions tunneling towards an Implantable Pulse Generator to the trunk. Data were collected retrospectively. Subject-reported outcome was measured via numerical rating scale values on a 10-point scale measuring pain intensity at rest and in motion. Additional data were collected for the subjects treated at the Charité location, including quality of life with the SF-36 form, quality of sleep with the Pittsburgh Sleep Quality Index and mood states with the short form of the General Depression Scale. Thirty-three patients received direct to permanent implant, landmark-guided peripheral nerve stimulation of the saphenous nerve branches. Six (18.2%) subjects reported non-sufficient initial benefit from the therapy and were explanted. Two subjects were explanted due to wound infections. The total study population reported included 25 patients. These subjects reported significant improvements related to pain, quality of life, mood quality, and quality of sleep. Additionally, subjects were able to reduce their opioid medication significantly after PNS therapy. Externally powered PNS at the saphenous nerve branches is a straightforward, selective and safe technique for patients with chronic knee pain. The landmark-guided implantation technique is less invasive than classical neuromodulation techniques such as spinal cord or DRGS and complication rates remain low. Short-term results are promising and show considerable reductions in pain scores and opioid intake. Long-term results are pending.

ID: 207779 Peripheral Nerve Stimulation for the Treatment of Chronic Knee Pain: A Retrospective Case Series

Peripheral nerve stimulation (PNS) is a promising novel treatment modality for the management of chronic knee pain.1,2 Multiple studies have suggested that PNS is effective in the treatment of post-surgical knee pain.3-5 Fewer data, however, exist to support the use of PNS in the pre-surgical setting. This investigation seeks to clarify the potential clinical utility of PNS for the treatment of chronic knee pain amongst patients who have failed conservative measures.

ID: 207995 Treatment of Chronic Knee Pain After Total Knee Replacement With Motor Stimulation

Although most experience successful outcome after total knee replacement (TKA), approximately 20% experience chronic knee pain after TKA. Existing treatments each have their limitations. Percutaneous motor peripheral nerve stimulation (mPNS) of the knee is a novel minimally invasive procedure that stimulates motor end points leading to muscle contraction associated with the painful joint. We report 3 patients who underwent mPNS for treatment of refractory OA knee pain.

A clinician's perspective on the role of imaging in knee osteoarthritis in clinical practice.

Knee osteoarthritis (OA) is a highly prevalent and disabling disease. Most persons age 45 and over with chronic knee pain have OA and with characteristic history and physical findings, diagnostic imaging is usually not necessary. Further, treatment of chronic knee pain with or without evidence of OA is similar, so imaging does not usually alter therapy. The exception is atypical presentations, such as sudden onset of pain perhaps after trauma or evidence of arthritis in atypical locations elsewhere in the body. Imaging is also unnecessary to follow patients. Given the absence of treatments that slow progression, there is little rationale for acquiring repeated imaging. However, ultrasound or other knee imaging may be helpful in locating the joint when carrying out intraarticular corticosteroid injections. There is controversy as to whether imaging should be acquired before these injections, but recent studies suggest no increased risk of disease progression for most persons receiving these injections. While guidelines currently discourage imaging in the diagnosis or management of most persons with OA, this may change for individuals with identifiable correctible lesions, when effective treatments that alter progression emerge or when imaging is used to identify subtypes of disease that may respond to specific treatments.

Treatment of Chronic Knee Pain Using Radiofrequency Ablation: Multicenter, Real-World Observational Study

Treatment of Chronic Knee Pain Using Radiofrequency Ablation: Multicenter, Real-World Observational Study

The Effectiveness of Fluoroscopically-Guided Genicular Nerve Radiofrequency Ablation for the Treatment of Chronic Knee Pain Due to Osteoarthritis: A Systematic Review

The Effectiveness of Fluoroscopically-Guided Genicular Nerve Radiofrequency Ablation for the Treatment of Chronic Knee Pain Due to Osteoarthritis: A Systematic Review

A Pilot Study of an Expanded Genicular Nerve Radiofrequency Ablation Protocol for the Treatment of Chronic Knee Pain.

A Pilot Study of an Expanded Genicular Nerve Radiofrequency Ablation Protocol for the Treatment of Chronic Knee Pain.

The Effectiveness of Fluoroscopically Guided Genicular Nerve Radiofrequency Ablation for the Treatment of Chronic Knee Pain Due to Osteoarthritis: A Systematic Review.

The objective was to determine the effectiveness of fluoroscopically guided genicular nerve radiofrequency ablation for painful knee osteoarthritis. Primary outcome measure was improvement in pain after 6 mos. Secondary outcomes included the Oxford Knee Score and Western Ontario and McMaster Universities Osteoarthritis Index. Two reviewers independently assessed publications before October 10, 2020. The Cochrane Risk of Bias Tool and Grades of Recommendation, Assessment, Development, and Evaluation system were used. One hundred ninety-nine publications were screened, and nine were included. Six-month success rates for 50% or greater pain relief after radiofrequency ablation ranged from 49% to 74%. When compared with intra-articular steroid injection, the probability of success was 4.5 times higher for radiofrequency ablation (relative risk = 4.58 [95% confidence interval = 2.61-8.04]). When radiofrequency ablation was compared with hyaluronic acid injection, the probability of treatment success was 1.8 times higher (relative risk = 1.88, 95% confidence interval = 1.38-2.57). The group mean Oxford Knee Score and Western Ontario and McMaster Universities Osteoarthritis Index scores improved in participants receiving genicular radiofrequency ablation compared with intra-articular steroid injection and hyaluronic acid injection. According to Grades of Recommendation, Assessment, Development, and Evaluation, there is moderate-quality evidence that fluoroscopically guided genicular radiofrequency ablation is effective for reducing pain associated with knee osteoarthritis at minimum of 6 mos. Further research is likely to have an important impact on the current understanding of the long-term effectiveness of this treatment.

Genicular Nerve Radiofrequency Ablation for Chronic Knee Pain Using a Three-Tined Electrode: A Technical Description and Case Series.

Genicular nerve radiofrequency ablation (RFA) for the treatment of chronic knee pain has traditionally targeted the superomedial, superolateral, and inferomedial genicular nerves. However, recent cadaveric studies of knee neuroanatomy demonstrate varied locations of these specific nerves as well as additional articular nerves. This work suggests that traditional genicular nerve RFA lesion locations may be inadequate. 1) To describe a novel protocol utilizing a three-tined RFA electrode to target the superomedial (SMGN), superolateral (SLGN), and inferomedial genicular nerves (IMGN), as well as the terminal articular branches of the nerves to the vastus medialis (NVM), intermedius (NVI), and lateralis (NVL). 2) To assess the ability of this technique to reduce chronic knee pain. Case series of consecutive patients with six or more months of refractory knee pain who underwent genicular nerve RFA according to the novel protocol described. Seven discrete RFA lesions were placed to target the SMGN, NVM, NVI, NVL, SLGN, and IGMN. Eleven patients underwent RFA, nine with knee osteoarthritis and two postarthroplasty. At one month, 91% (95% CI = 59-100%), 82% (95% CI = 48-98%), and 9% (95% CI = 2-41%), of patients reported ≥50%, ≥80%, and 100% improvement in knee pain on the numeric rating scale, respectively. These results were sustained at six months. There were no complications. These preliminary data suggest the feasibility and possible effectiveness of genicular nerve RFA using the described novel protocol including a three-tined electrode. Larger-scale studies with comparative groups are warranted.

High-Voltage Intraarticular Pulsed Radiofrequency for Chronic Knee Pain Treatment: A Single-Center Retrospective Study

Background: Intraarticular pulsed radiofrequency (IAPRF) for the treatment of painful knee osteoarthritis (KOA) is a less invasive treatment method. It has fewer adverse effects and can quickly reduce KOA-related pain and improve knee joint dysfunction. Objectives: We compared the effectiveness of high- and low-voltage IAPRF for the treatment of chronic knee pain. Study Design: Retrospective comparative study design. Setting: This study took place at Shengjing Hospital of China Medical University. Methods: A total of 57 patients with KOA who were hospitalized between July 2018 and July 2019 were randomly allocated into the high-voltage (n = 29) and low-voltage (n = 28) IAPRF groups. IAPRF was performed under the guidance of computed tomography (CT). Numeric Rating Scale (NRS-11), Oxford Knee Score (OKS), degree of pain relief, global perceived effect, and side effects at baseline and 1 week, 2 weeks, 1 month, 3 months, and 6 months after the procedure were recorded and analyzed. Results: NRS-11 scores decreased significantly in both groups after the procedure, but gradually increased after the 6-month follow-up period. There was a significant difference in NRS-11 scores between the 2 groups at all follow-up periods postprocedure. OKS were similar between the 2 groups. Patients with pain relief rate 50% or greater at 1, 3, and 6 months after the procedure accounted for 72.41%, 72.41%, and 55.17% in the high-voltage group, and 46.43%, 46.43%, and 28.57% in the low-voltage group, respectively. The difference between the 2 groups was statistically significant. No significant adverse reactions were observed in the 2 groups, however, patient satisfaction in the high-voltage group was significantly higher compared with patients in the low-voltage group. Limitations: This study was a single-center retrospective study with a relatively small sample cohort and short follow-up period. Conclusions: CT-guided high-voltage IAPRF is more beneficial in reducing knee pain and improving knee function compared with low-voltage IAPRF. In addition, patients who received high-voltage IAPRF were more satisfied with their treatment. Key words: Pulsed radiofrequency, knee osteoarthritis, intraarticular, high voltage, Oxford Knee Score, Numeric Rating Scale

The effect of extra-osseous talotarsal stabilization (EOTTS) to reduce medial knee compartment forces - An in vivo study.

BackgroundExcessive hindfoot pronation, talotarsal joint (TTJ) instability, has been attributed to an increase in medial knee compartment pathology. Advocacy for hindfoot realignment has been the subject of research. An internal solution for TTJ instability, extra-osseous talotarsal stabilization (EOTTS), exists but its effect on knee forces is unknown. This is the first study to measure the in vivo forces acting within the medial knee compartment before and after EOTTS. We hypothesized that following EOTTS there should be a reduction of force acting on the medial knee compartment.Methods10 fresh frozen cadaver lower extremities exhibiting clinical and radiographic evidence of TTJ instability were evaluated. The proximal femur segment was mounted to a mechanical testing unit. Pressure sensors were placed within the medial knee compartment. A force of 1000 newtons was then applied, and the femur was internally rotated 10 degrees. Measurements were recorded before and after the insertion of a type II EOTTS stent.ResultsPre-EOTTS resulted in an average of 842 ± 247N acting within the medial knee joint compartment. These forces then decreased to an average of 565 ± 260N (<0.05) following EOTTS, representing an average reduction of force by 32.8%.ConclusionEOTTS has been shown to decrease the in vivo forces action within the medial knee compartment. This helps to further illustrate the importance of realigning and stabilizing the hindfoot for the prevention and treatment of chronic knee pain.

Long-Term Retrospective Assessment of Clinical Efficacy of Radiofrequency Ablation of the Knee Using a Cooled Radiofrequency System

Background: Cooled radiofrequency ablation (CRFA) in a randomized, prospective study demonstrated significantly greater improvements in pain, functional, and global outcome measures. Objectives: This large, real-life, retrospective study evaluated the long-term effectiveness of CRFA in the general chronic knee pain population. Study Design: Retrospective electronic chart review. Setting: Outpatient private practice. Methods: After institutional review board approval, we reviewed data of 275 consecutive patients who had undergone a geniculate nerve block at a single-site pain practice between July 1, 2014 and July 1, 2017. A total of 44 patients had a negative response to the geniculate block, and 11 patients had long-term pain relief from the block and declined CRFA. Eight patients underwent knee surgery after the block, and 7 never followed up for further treatment. Finally, 205 patients had undergone CRFA, and 183 (89%) of them returned to provide data. Results: The average age of the 183 patients was 61 (28-95) years, body mass index 34 (18.5- 57), and there were 105 women and 78 men. A total of 137 patients had unilateral knee pain, whereas 46 patients had bilateral knee pain. Eighty percent (146/183) reported at least one or more additional sources of chronic pain (back, shoulder, and others). The average opioid use at baseline was 50 mg morphine sulfate equivalents (median 30 mg). The average baseline pain scores were 8.5, which decreased to 2.2 after the geniculate local anesthetic block, and to 4.2 after CRFA. A total of 65% of the patients claimed &gt; 50% pain relief, whereas 77% had 2 or more Visual Analog Scale points decrease, and 26 (14%) patients reported no pain at all after CRFA. The mean duration of &gt; 50% pain relief after CRFA was 12.5 months (range 0-35 months). There was no significant decrease of opioid use. Patients who underwent a repeated procedure (n = 43) achieved a similar pain relief (P = 0.402). We could not find a statistical difference in geniculate CRFA outcomes between the group who had total knee arthroplasty (TKA; n = 21) and maintained chronic knee pain and patients who had no prior surgery (P = 0.542). Limitations: Retrospective nature of the study. Conclusions: This study demonstrates the clinical effectiveness of CRFA in the treatment of chronic knee pain from osteoarthritis, and even in those patients who maintained chronic knee pain after TKA. Our real-life data seems to agree with data previously published in a randomized controlled trial, despite the fact that this was quite a heterogenous patient population with various sources of chronic pain. Key words: Radiofrequency ablation, chronic knee pain, knee osteoarthritis

HF10 Treatment of Chronic Knee Pain

HF10 Treatment of Chronic Knee Pain

Gonartroz Hastalarında Ultrason Eşliğinde Uygulanan Geniküler Sinir Pulsed Radyofrekans Tedavisinin Ağrı ve Diz Fonksiyonlarına Uzun Dönem Etkisi

Objective : Osteoarthritis of the knee is the most common musculoskeletal disease in older adults which causes chronic knee pain. Pulsed radiofrequency (PRF) on genicular nerves (GN) has become increasingly popular in the treatment of chronic knee pain due to its long duration of action and non-destructive therapy. This study aimed to reveal the effects of ultrasound-guided PRF therapy on GN in patients with knee osteoarthritis (KOA). Materials and Methods: This study included patients, who were diagnosed with gonarthrosis grade 3 to 4 according to the Kellgren-Lawrence classification which patients suffered from intractable knee pain, at least for six months despite conservative treatment. The ultrasound-guided PRF on GN (GPRF) was performed in those patients with a reduction of 50% or more visual analog scale (VAS) score after the diagnostic GN block (GNB). VAS and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated before, and 1, 3, 6 and 12 months after the procedure. Results: Of the 293 patients included in the criteria, ultrasound-guided GPRF was administered to 232 patients who responded to GNB. While the mean VAS score of the patients before the GPRF was 6.77 ± 1.24, the mean VAS scores at the 1st, 3rd, 6th and 12th months of the GPRF were 2.76 ± 1.14, 2.94 ± 1.08, 3.53 ± 0.64, and 4.58 ± 0.75, respectively. The mean WOMAC score of the patients before GPRF was 65.75 ± 14.15, while the mean WOMAC score of the 1st, 3rd, 6th and 12th months after GPRF was 36.14 ± 13, 36.52 ± 11.06, 37.88 ± 10.86, and 41.67 ± 10.84, respectively. Conclusion: Ultrasound-guided GPRF therapy in chronic knee pain which does not respond to conservative treatments reduces pain for at least 12 months and is effective improving knee functions.

The Efficacy of Ultrasound-Guided Pulsed Radiofrequency of Genicular Nerves in the Treatment of Chronic Knee Pain Due to Severe Degenerative Disease or Previous Total Knee Arthroplasty.

BackgroundPulsed radiofrequency of genicular nerves in the management of osteoarthritis related chronic knee pain has recently become a promising treatment. Ultrasonography has replaced fluoroscopic guidance in pain medicine. The aim of this study was to investigate the effect of ultrasound-guided genicular pulsed radiofrequency on knee pain and function in patients who had severe knee osteoarthritis or who had previous knee arthroplasty.Material/MethodsThe retrospective study included a total of 23 patients with chronic knee pain, of which 17 patients were included in Group I (non-operated), and 6 patients were included in Group II (post-arthroplasty). Treatment was based on ultrasound-guided pulsed radiofrequency of the superior medial, superior lateral, and inferior medial genicular nerves. The Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores were assessed before treatment, and at 3 weeks and at 3 months following the procedure.ResultsPulsed radiofrequency of the genicular nerves significantly reduced perceived pain and disability in the majority of the patients. The proportion of the patients with improvement of ≥50% in pretreatment VAS scores at 3 weeks and 3 months following treatment were 14 out of 17 patients (82%) and 15 out of 17 patients (88%) in Group 1, and 4 out of 6 patients (67%), 4 out of 6 patients (67%) in Group 2, respectively.ConclusionsOur study results suggest that ultrasound-guided pulsed radiofrequency of genicular nerves is a safe and minimally invasive procedure that significantly alleviates pain and disability in patients with severe degenerative disease or with previous knee arthroplasty.

Cooled Radio Frequency Ablation for the Treatment of Osteoarthritis-Related Knee Pain: Evidence, Indications, and Outcomes.

Knee osteoarthritis (OA) is a common condition associated with pain and physical impairment in a large segment of the population. The traditional treatment algorithm progresses from conservative modalities to nonsurgical options to surgical intervention. Surgical intervention often provides reliable pain relief but not all patients are surgical candidates and there are some patients who prefer not to have surgery. Cooled radio frequency ablation (C-RFA) is a treatment with the potential to provide pain relief for patients who no longer benefit from noninvasive modalities and who desire an alternative to surgery. The objective of this review article is to provide the rationale, available evidence, indications, and outcomes associated with C-RFA for the treatment of chronic knee OA. A total of eight reports that use C-RFA in the treatment of chronic knee pain were identified and analyzed. There were two prospective trials, one retrospective cohort study, and five case reports or case series. C-RFA is an emerging procedure with encouraging early results; however, additional long-term prospective clinical trials are necessary to further characterize how C-RFA can best be used to treat chronic knee pain.

Endoscopic Pulsed Radiofrequency Ablation of Genicular Nerves for the Treatment of Chronic Knee Pain

Chronic knee pain is the second most common cause of chronic pain in the United States. Occasionally, patients become refractory to conventional treatments such as intraarticular cortisone injections and viscosupplementation. Patients who have exhausted these therapies or have a contraindication to the therapies may be candidates for diagnostic genicular nerve block and if successful, subsequent radiofrequency ablation (RFA). For patients who have undergone image-guided genicular nerve radiofrequency ablation with fluoroscopic or ultrasound guidance without success, an endoscopic approach can be used as an alternative modality with success. With direct visualization of the genicular nerves, the likelihood of success with an endoscopic approach increases as some patients can have varying anatomy of the genicular nerves for which cannot always be detected with fluoroscopy or ultrasound. The purpose of this study is to demonstrate the utilization of a direct endoscopic approach for genicular nerve RFA for patients with chronic knee pain that have failed to improve after image-guided genicular RFA with fluoroscopic or ultrasound guidance. Two patients who had underwent successful diagnostic genicular nerve blocks were assessed for pre-procedure and post-procedure visual analog scale (VAS) scores following endoscopic genicular nerve RFA after failure of the conventional image guided approach at 6 and 12 months. Both patients reported greater than 80% reduction in VAS score and improvement in function at 6 and 12 months Limitations of the current study is a limited number of patients, and lack of the use of a formal functional scale to demonstrate improvement. Ultimately, the conclusion was drawn that an endoscopically-guided genicular nerve RFA can be utilized successfully due to direct visualization of the genicular nerves when conventional approaches with Fluoroscopic/ultrasound guidance has failed to achieve analgesia and functional improvement. Key words: Genicular nerve block, endoscopic, radiofrequency ablation. knee pain, chronic osteoarthritis, genicular neuritis, genicular neuralgia, total knee arthroplasty, arthritis

C11 Zap It: Genicular Nerve Radiofrequency Ablation for the Treatment of Chronic Knee Pain

C11 Zap It: Genicular Nerve Radiofrequency Ablation for the Treatment of Chronic Knee Pain

Updated systematic review and meta-analysis of acupuncture for chronic knee pain.

To assess the effectiveness and safety of acupuncture for the treatment of chronic knee pain (CKP). We searched the MEDLINE, EMBASE, Cochrane CENTERAL, CINAHL and four Chinese medical databases from their inception to June 2017. We included randomised controlled trials of acupuncture as the sole treatment or as an adjunctive treatment for CKP. The primary outcome was pain intensity measured by visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and 11-point numeric rating scale. Secondary outcome measurements included the 36-Item Short Form Health Survey and adverse events. The quality of all included studies was evaluated using the Cochrane risk-of-bias criteria and the STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) checklist. Nineteen trials were included in this systematic review. Of these, data from 17 studies were available for analysis. Regarding the effectiveness of acupuncture alone or combined with other treatment, the results of the meta-analysis showed that acupuncture was associated with significantly reduced CKP at 12 weeks on WOMAC pain subscale (mean difference (MD) -1.12, 95% confidence interval (CI) -1.98 to -0.26, I2=62%, 3 trials, 608 participants) and VAS (MD -10.56, 95% CI -17.69 to -3.44, I2=0%, 2 trials, 145 patients). As for safety, no difference was found between the acupuncture and control groups (risk ratio 1.08, 95% CI 0.54 to 2.17, I2=29%). From this systematic review, we conclude that acupuncture may be effective at relieving CKP 12 weeks after acupuncture administration, based on the current evidence and our protocol. However, given the heterogeneity and methodological limitations of the included trials, we are currently unable to draw any strong conclusions regarding the effectiveness of acupuncture for chronic knee pain. In addition, we found that acupuncture appears to have a satisfactory safety profile, although further studies with larger numbers of participants are needed to confirm the safety of this technique. Systematic review without language restrictions. Only a few high-quality and consistent trials could be included in this review.