Radiofrequency Ablation of the Infrapatellar Branch of the Saphenous Nerve for the Treatment of Chronic Anterior Inferomedial Knee Pain

Abstract

Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for chronic knee pain related to osteoarthritis. It is often utilized when conservative management has failed and patients wish to avoid arthroplasty, are poor surgical candidates due to co-morbid medical conditions, or in those suffering from persistent pain after arthroplasty. The classic targets for GNRFA include the superior lateral genicular nerve, superior medial genicular nerve, and inferior medial genicular nerve but multiple anatomic studies have demonstrated additional sensory innervation to the knee. In this research article, we propose an image-guided technique that can safely target the infrapatellar branch of the saphenous nerve which also provides sensory innervation to the anterior capsule. The proposed technique includes variations for conventional bipolar radiofrequency ablation, cooled radiofrequency ablation, dual-tined bipolar radiofrequency ablation, and monopolar radiofrequency ablation using a long axis approach. The described technique is based on updated anatomic studies and takes into account safety concerns such as thermal risk to the skin and/or pes anserine tendons and breaching of the synovial cavity. Future clinical research should be performed to confirm the safety and effectiveness of this specific approach.

Anterior knee pain and sit‐up tests predicts patients’ satisfaction and improvement in quality of life after anterior stabilized total knee replacement without patellar resurfacing

“…Subsequently, an interdisciplinary approach must be taken for pain management [ 13 , 41 ]. Radiofrequency ablation of the genicular nerves has been proposed for treating anterior knee pain in patients with osteoarthritis, mainly in patients with a high perioperative risk [ 6 ]. This interventional technique could also maximise results after TKA, especially in those with a documented neuroma [ 15 ], but also in patients unsatisfied by anterior knee pain without a clear cause.…”

Minimally invasive interventional therapy for pain

“…With an in-depth study of neuroanatomy and advanced temperature control technology, radiofrequency thermocoagulation will become a common minimally invasive technique for the treatment of pain in the future. 7 , 9 …”