Review

. 2024 Sep 13;14(9):970.

doi: 10.3390/jpm14090970.

Minimally Invasive Therapies for Knee Osteoarthritis

Uchenna Osuala¹, Megan H Goh², Arian Mansur², John B Smirniotopoulos^{1

3}, Arielle Scott⁴, Christine Vassell⁴, Bardia Yousefi⁴, Neil K Jain³, Alan A Sag⁵, Allison Lax⁶, Kevin W Park⁷, Alexander Kheradi⁸, Marc Sapoval⁹, Jafar Golzarian^{10

11}, Peiman Habibollahi¹², Osman Ahmed¹³, Shamar Young¹⁴, Nariman Nezami^{1

15

16}

Affiliations

¹ Georgetown University School of Medicine, Washington, DC 20007, USA.
² Harvard Medical School, Cambridge, MA 02115, USA.
³ Division of Vascular and Interventional Radiology, MedStar Washington Hospital Center, Washington, DC 20010, USA.
⁴ Department of Bioengineering, University of Maryland College Park, College Park, MD 20742, USA.
⁵ Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC 27705, USA.
⁶ Department of Radiology, MedStar Georgetown University Hospital, Washington, DC 20007, USA.
⁷ Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC 20007, USA.
⁸ Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, USA.
⁹ Hôpital Européen Georges-Pompidou, 75015 Paris, France.
¹⁰ North Star Vascular and Interventional Institute, Minnesota, MN 55427, USA.
¹¹ Department of Radiology, Division of Vascular and Interventional Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA.
¹² Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
¹³ Division of Interventional Radiology, Rush University Medical Center, Chicago, IL 60612, USA.
¹⁴ Division of Interventional Radiology, Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ 85712, USA.
¹⁵ Division of Vascular and Interventional Radiology, MedStar Georgetown University Hospital, Washington, DC 20007, USA.
¹⁶ Lombardi Comprehensive Cancer Center, Washington, DC 20007, USA.

PMID: 39338224
PMCID: PMC11432885
DOI: 10.3390/jpm14090970

Review

Minimally Invasive Therapies for Knee Osteoarthritis

Uchenna Osuala et al. J Pers Med. 2024.

. 2024 Sep 13;14(9):970.

doi: 10.3390/jpm14090970.

Authors

Affiliations

¹ Georgetown University School of Medicine, Washington, DC 20007, USA.
² Harvard Medical School, Cambridge, MA 02115, USA.
³ Division of Vascular and Interventional Radiology, MedStar Washington Hospital Center, Washington, DC 20010, USA.
⁴ Department of Bioengineering, University of Maryland College Park, College Park, MD 20742, USA.
⁵ Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC 27705, USA.
⁶ Department of Radiology, MedStar Georgetown University Hospital, Washington, DC 20007, USA.
⁷ Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC 20007, USA.
⁸ Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, USA.
⁹ Hôpital Européen Georges-Pompidou, 75015 Paris, France.
¹⁰ North Star Vascular and Interventional Institute, Minnesota, MN 55427, USA.
¹¹ Department of Radiology, Division of Vascular and Interventional Radiology, University of Minnesota Medical School, Minneapolis, MN 55455, USA.
¹² Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
¹³ Division of Interventional Radiology, Rush University Medical Center, Chicago, IL 60612, USA.
¹⁴ Division of Interventional Radiology, Department of Medical Imaging, University of Arizona Medical Center, Tucson, AZ 85712, USA.
¹⁵ Division of Vascular and Interventional Radiology, MedStar Georgetown University Hospital, Washington, DC 20007, USA.
¹⁶ Lombardi Comprehensive Cancer Center, Washington, DC 20007, USA.

PMID: 39338224
PMCID: PMC11432885
DOI: 10.3390/jpm14090970

Abstract

Knee osteoarthritis (KOA) is a musculoskeletal disorder characterized by articular cartilage degeneration and chronic inflammation, affecting one in five people over 40 years old. The purpose of this study was to provide an overview of traditional and novel minimally invasive treatment options and role of artificial intelligence (AI) to streamline the diagnostic process of KOA. This literature review provides insights into the mechanisms of action, efficacy, complications, technical approaches, and recommendations to intra-articular injections (corticosteroids, hyaluronic acid, and plate rich plasma), genicular artery embolization (GAE), and genicular nerve ablation (GNA). Overall, there is mixed evidence to support the efficacy of the intra-articular injections that were covered in this study with varying degrees of supported recommendations through formal medical societies. While GAE and GNA are more novel therapeutic options, preliminary evidence supports their efficacy as a potential minimally invasive therapy for patients with moderate to severe KOA. Furthermore, there is evidentiary support for the use of AI to assist clinicians in the diagnosis and potential selection of treatment options for patients with KOA. In conclusion, there are many exciting advancements within the diagnostic and treatment space of KOA.

Keywords: AI for knee osteoarthritis; genicular artery embolization; genicular nerve ablation; knee osteoarthritis; regenerative and experimental therapies.

PubMed Disclaimer

Conflict of interest statement

N. N. owns IRAD Graphics and Info Med Solution, and consults for CAPS Medical and Boston Scientific.

Figures

**Figure 1**
Weight-bearing anterior-posterior radiographs of knees in various stages of osteoarthritis. (a) KL grade 0—no radiographic features of OA; (b) KL grade 1—possible osteophytic lipping of the medial and lateral compartments and doubtful joint space narrowing; (c) KL grade 2—medial osteophyte (white arrow) with possible lateral joint space narrowing; (d) KL grade 3—multiple osteophytes (white arrows), definite narrowing of the medial compartment, and sclerosis of the medial tibial plateau (red arrow); (e) KL grade 4—multiple large osteophytes (white arrows), severe narrowing of the medial joint space, significant subchondral sclerosis (red arrows) although bone deformity is not present in this case.

**Figure 2**
Coronal MR images of healthy (a,b) and osteoarthritic (c,d) knees. (a) T1-weighted and (b) fat-suppressed proton density-weighted images demonstrating no evidence of OA and normal soft tissue structures; (c) T1-weighted MR image showing joint space narrowing and multiple osteophytes (white arrows); (d) fat-suppressed proton density-weighted MR image demonstrating significant cartilage loss of the medial compartment and mild subchondral bone marrow edema of the medial plateau (green arrow) and extrusion of the body segment of the medial meniscus (blue arrow).

**Figure 3**
Annotated digital subtraction angiogram (DSA) depicting the genicular artery embolization with red arrowheads identifying radiopaque marker for the painful area. (a) Proximal popliteal artery early-phase angiogram showing the descending genicular artery (DGA), superior lateral genicular artery (SLGA), superior medial genicular artery (SMGA), medial sural artery (MSA), inferior lateral genicular artery (ILGA), and inferior medial genicular artery (IMGA); (b) delayed phase of DSA with inflammatory blush surrounding the painful areas identified with radiopaque markers (red arrowheads); (c) selective post-embolization DSA of SMGA; (d) selective post-embolization DSA of ILGA, since it was back supplying the SMGA angiozone; and (e) final post-embolization DSA from popliteal artery showing resolution of the inflammatory blush.

**Figure 4**
Targets and approach to genicular nerve ablation (GNA) procedure. (a) Schematic of knee innervation with target areas distinguished by X; (b) picture of the sterile field during GNA procedure; (c) fluoroscopic AP; and (d) lateral view of left knee demonstrating needle placement during the four-probe approach to GNA. Probes are placed near the bone to target the suprapatellar (SP), superomedial (SM), superolateral (SL), and inferomedial (IM) nerves.

**Figure 5**
Artificial intelligence methodology for knee osteoarthritis [38,114,116,117,118,119,120,121,122,123,124,125,126,127].

See this image and copyright information in PMC

References

1. Heidari B. Knee Osteoarthritis Prevalence, Risk Factors, Pathogenesis and Features: Part I. Casp. J. Intern. Med. 2011;2:205. - PMC - PubMed
1. Cui A., Li H., Wang D., Zhong J., Chen Y., Lu H. Global, Regional Prevalence, Incidence and Risk Factors of Knee Osteoarthritis in Population-Based Studies. EClinicalMedicine. 2020;29–30:100587. doi: 10.1016/j.eclinm.2020.100587. - DOI - PMC - PubMed
1. KELLGREN J.H., LAWRENCE J.S. Radiological Assessment of Osteo-Arthrosis. Ann. Rheum. Dis. 1957;16:494–502. doi: 10.1136/ard.16.4.494. - DOI - PMC - PubMed
1. Bedson J., Croft P.R. The Discordance between Clinical and Radiographic Knee Osteoarthritis: A Systematic Search and Summary of the Literature. BMC Musculoskelet. Disord. 2008;9:116. doi: 10.1186/1471-2474-9-116. - DOI - PMC - PubMed
1. Yusuf E., Kortekaas M.C., Watt I., Huizinga T.W.J., Kloppenburg M. Do Knee Abnormalities Visualised on MRI Explain Knee Pain in Knee Osteoarthritis? A Systematic Review. Ann. Rheum. Dis. 2011;70:60–67. doi: 10.1136/ard.2010.131904. - DOI - PubMed

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Minimally Invasive Therapies for Knee Osteoarthritis

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Minimally Invasive Therapies for Knee Osteoarthritis

Authors

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Abstract

Conflict of interest statement

Figures

References

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