Case ReportCASE REPORTS AND CLINICAL OBSERVATIONS
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Ultrasonography- and Fluoroscopy-Guided Technique for Cooled Radiofrequency Ablation of the Genicular Nerves for Knee Joint Pain

Swapnil Kumar Barasker, Anuj Jain, Sujeet Gautam and Dipti Saxena
Ochsner Journal December 2024, 24 (4) 303-308; DOI: https://doi.org/10.31486/toj.24.0038

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Anteroposterior and lateral views in the standing position for the (A) right knee joint of Case 1 and the (B) left knee joint of Case 2. Both x-rays show Kellgren and Lawrence grade 4 osteoarthritis, with severe joint space narrowing compromising the medial and lateral compartments, severe sclerosis, and multiple osteophytes.

  • Figure 2.
    Figure 2.

    Ultrasonography scan for the right superolateral genicular artery. (A) The ultrasonography scanning is started from the lateral knee joint line, and the ultrasound probe is moved to the metaphyseal-diaphyseal junction of the femur superiorly, looking for the genicular artery overlying the periosteum. Once the genicular artery is visualized, the artery is centralized as per the center point mark on the ultrasonography machine screen. The ultrasound probe's central points are marked at 4 sites: 2 along the longitudinal axis and 2 along the transverse axis of the ultrasound probe. (B) Ultrasonography image with color scan of the superolateral metaphyseal-diaphyseal junction of the femur shows the centralized genicular artery with the center of the ultrasonography screen.

  • Figure 3.
    Figure 3.

    (A) The marked points after removal of the ultrasound probe. (B) The longitudinal and transverse marked points are joined using a ruler. (C) The joined lines have an intersection point.

  • Figure 4.
    Figure 4.

    (A) A metal marker is moved over the transverse line to select the entry point. (B) The corresponding fluroscopy image shows the metal marker overlying the target area.

  • Figure 5.
    Figure 5.

    The final needle positions for the superolateral, superomedial, and inferomedial genicular nerves in (A) anteroposterior and (B) lateral views.

  • Figure 6.
    Figure 6.

    Determining the depth of needle insertion. The line from a to a′ is the transverse line. The line from b to b′ is the longitudinal line. The point of intersection of the 2 lines is denoted by c. The point of skin entry is denoted by d (green rectangle). This point is determined on anteroposterior fluroscopic view, at the junction of the metal marker over the bone as defined in Figure 4. The approximate required depth of needle insertion can be calculated by measuring the distance between d and c.

Tables

  • Table.

    Patient Characteristics and Outcomes

    Pre-CRFAPost-CRFA, 3 monthsPost-CRFA, 6 months
    CaseAge, years/SexOA Gradea/LocationVASWOMACDiagnostic Block ReliefbVASWOMACVASWOMAC
    178/M4/Right knee8/1064/96>70%1/1033/962/1039/96
    260/F4/Left knee7/1062/96>70%2/1032/963/1039/96

    • ↵aAssessed with the Kellgren and Lawrence scale, in which grade 0 signifies no osteoarthritis and grade 4 signifies severe osteoarthritis.

    • ↵b≥2 hours.

    • Notes: The visual analog scale (VAS) ranges from 0 to 10, with 0 corresponding to no pain and 10 corresponding to worst pain. Scores for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) range from 0 to 96, with higher scores denoting higher levels of functional difficulty.

    • CRFA, cooled radiofrequency ablation; F, female; M, male; OA, osteoarthritis; VAS, visual analog scale; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index.

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