Feasibility of an ultrasound-guided approach to radiofrequency ablation of the superolateral, superomedial and inferomedial genicular nerves: a cadaveric study

• Published in: Regional anesthesia and pain medicine Vol. 44; no. 10; pp. 966 - 970
• Main Authors: Vanneste, Bert, Tomlinson, Joanna, Desmet, Matthias, Krol, Andrzej
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.10.2019; Copyright by American Society of Regional Anesthesia and Pain Medicine; BMJ Publishing Group LTD
• Subjects: Ablation; anatomy; Cadavers; Chronic and Interventional Pain; Denervation; genicular; Knee; Older people; Patients; Regional anesthesia; Ultrasonic imaging; United States > US; genicular; knee; denervation; anatomy
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1136/rapm-2019-100381

IntroductionGenicular nerve radiofrequency (RF)denervation appears to be a promising treatment for knee pain in patients with degenerative osteoarthritis of the knee, when candidates are not suitable for arthroplasty. This study aimed to assess the accuracy and reliability of ultrasound-guided placement of RF cannulas in cadavers for genicular nerve treatment, by measuringthe needle-to-nerve proximity.Materials and methodsFive soft-fix human cadavers were included in this study, totaling 10 knees (meanage 93.8 years). Using the ultrasound-guided technique,which we have described previously, RF cannulas were directed toward the superolateral genicular nerve(SLGN), the superomedial genicular nerve (SMGN) and the inferomedial genicular nerve (IMGN). Indocyaninegreen (ICG) dye (0.1 mL) was infiltrated. An anatomical dissection was performed and the distance from the center of the ICG mark to the genicular nerve concerned was measured.ResultsThe mean distances from the center of the ICG mark to the SLGN, SMGN and IMGN were 2.33 mm(range 0.00–6.05 mm), 3.44 mm (range 0.00–10.59mm) and 1.32 mm (range 0.00–2.99 mm), respectively. There was no statistical difference in distances from the center of the ICG mark to the targeted nerve between the different nerves (p=0.18).ConclusionThe results of this study demonstrate that ultrasound-guided treatment of the genicular nerves is feasible. However, for RF ablations, there are some limitations, which mostly can be overcome by using appropriate RF ablation settings.