Cooled radiofrequency ablation of genicular nerves for knee osteoarthritis

Abstract

Knee osteoarthritis (OA) is a prevalent and debilitating musculoskeletal condition that significantly affects the quality of life of millions of individuals worldwide. In recent years, cooled radiofrequency ablation (CRFA) has become a viable treatment option for knee OA. This review thoroughly evaluated the existing literature on CRFA therapy for knee OA. It delved into the mechanisms behind CRFA, evaluated its clinical efficacy, and investigated potential avenues for future research and application. The insights gained from this review are crucial for healthcare professionals, researchers, and policymakers, offering an updated perspective on CRFA's role as a viable therapeutic option for knee OA.

Keywords: Chronic Pain; Cooled Radiofrequency Ablation; Denervation; Hyaluronic Acid; Injections; Intra-Articular; Knee; Osteoarthritis; Radiofrequency Ablation; Steroids; Treatment Outcome.

Fig. 1

Cooled radiofrequency (RF) system consists of guide introducers and cooled radiofrequency probe, radiofrequency generator, and peristaltic pump unit.

Fig. 2

Schematic daiagram of the right anterior knee joint innervation for genicular nerves interventions. IMGN: inferior medial genicular nerve, SLGN: superior lateral genicular nerve, SMGN: superior medial genicular nerve, SPGN: suprapatellar genicular nerve.

Fig. 3

Ultrasound-guided superior medial genicular nerve block. Representative longitudinal images of the right knee at the level of the distal femoral epicondyle and medial metaphysis of femur is shown. The superior medial genicular nerves accompany each the superior medial genicular artery which is identified using color Doppler mode. Dashed arrow indicates the out-of-plane needle pathway for the superior medial genicular nerve block.

Fig. 4

Fluoroscopic images of the cooled radiofrequency ablation for genicular nerves of the left knee. (A) Anteroposterior fluoroscopic view after cannula insertion for the placement of cooled radiofrequency electrodes into the junction between the shaft and epicondyle of the tibia and femur. (B) Location of electrodes for the cooled radiofrequency ablation of genicular nerves in the lateral fluoroscopic image. Optionally, the suprapatellar genicular intervention can be performed by inserting the needle 3 cm above the superior patella border at the midline of the anterior distal femoral diaphysis (asterisk). Dashed arrow indicates the needle pathway for the suprapatellar genicular intervention.