A Prospective Randomized Trial of Prognostic Genicular Nerve Blocks to Determine the Predictive Value for the Outcome of Cooled Radiofrequency Ablation for Chronic Knee Pain Due to Osteoarthritis

McCormick, Zachary L; Reddy, Rajiv; Korn, Marc; Dayanim, David; Syed, Raafay H.; Bhave, Meghan; Zhukalin, Mikhail; Choxi, Sarah; Ebrahimi, Ali; Kendall, Mark C.; McCarthy, Robert J.; Khan, Dost; Nagpal, Geeta; Bouffard, K; Walega, David R.

doi:10.1093/pm/pnx286

Cited by 90 publications

(74 citation statements)

References 38 publications

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“…The complexity of the knee joint’s innervation has resulted in a disparity in procedural technique among the available controlled and observational studies. Studies report on a range of procedural targets to include the SM, IM, and SL genicular nerves in combination, 28 – 33 the saphenous nerve, 34 the sciatic nerve, 35 the IP genicular nerve, 36 the IP and SM genicular nerves in combination, 37 the femoral, tibial, saphenous nerves, and peripatellar plexus in combination, 38 and the intra-articular joint space 6 , 25 , 39 – 41 ( Figures 1 and 2 ).…”

Section: Introductionmentioning

confidence: 99%

“…The 2017 randomized trial by McCormick et al also employed CRFA, but the study was designed to determine the predictive value of pre-RFA nerve blocks, not to compare RFA to other modalities. 33 Fifty-four patients with chronic knee pain due to OA all received CRFA, but 29 did so after prognostic blocks and 25 did not. Notably, only three of 32 (9.3%) patients had a negative block, defined as <50% pain relief.…”

Section: Introductionmentioning

confidence: 99%

“…The McCormick et al trial specifically addressed the prognostic value of nerve blocks by comparing RFA outcomes performed after positive genicular nerve blocks to results obtained without the use of prior injections. 33 Blocks were performed with 1 mL of lidocaine, with a positive response defined as ≥50% pain reduction persisting for at least 1 hour following injection. Given the lack of statistical difference between the groups, the authors concluded that their method of genicular nerve block has little prognostic value.…”

Section: Introductionmentioning

confidence: 99%

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Radiofrequency techniques to treat chronic knee pain: a comprehensive review of anatomy, effectiveness, treatment parameters, and patient selection

Jamison

Cohen

2018

JPR

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BackgroundThe use of radiofrequency ablation (RFA) procedures to treat chronic knee pain has surged in the past decade, though many questions remain regarding anatomical targets, selection criteria, and evidence for effectiveness.MethodsA comprehensive literature review was performed on anatomy, selection criteria, technical parameters, results of clinical studies, and complications. Databases searched included MEDLINE and Google Scholar, with all types of clinical and preclinical studies considered.ResultsWe identified nine relevant clinical trials, which included 592 patients, evaluating knee RFA for osteoarthritis and persistent postsurgical pain. These included one randomized, placebo-controlled trial, one randomized controlled trial evaluating RFA as add-on therapy, four comparative-effectiveness studies, two randomized trials comparing different techniques and treatment paradigms, and one non-randomized, controlled trial. The results of these studies demonstrate significant benefit for both reduction and functional improvement lasting between 3 and 12 months, with questionable utility for prognostic blocks. There was considerable variation in the described neuroanatomy, neural targets, radiofrequency technique, and selection criteria.ConclusionRFA of the knee appears to be a viable and effective treatment option, providing significant benefit to well-selected patients lasting at least 3 months. More research is needed to better identify neural targets, refine selection criteria to include the use of prognostic blocks, optimize treatment parameters, and better elucidate relative effectiveness compared to other treatments.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radiofrequency techniques to treat chronic knee pain: a comprehensive review of anatomy, effectiveness, treatment parameters, and patient selection

Jamison

Cohen

2018

JPR

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“…At final follow-up (6-12 months), all patients reported at least an 80% improvement in knee pain and no patients went on to TKA. While the findings of this report are limited by sample size, when viewed in conjunction with the work from McCormick et al, 39 it appears that a robust response to the prognostic nerve block may be indicative of greater likelihood for clinical success following C-RFA.…”

Section: C-rfa Treatment For Knee Oa: Evidence and Outcomesmentioning

confidence: 53%

Cooled Radio Frequency Ablation for the Treatment of Osteoarthritis-Related Knee Pain: Evidence, Indications, and Outcomes

Oladeji

Cook

2018

J Knee Surg

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Knee osteoarthritis (OA) is a common condition associated with pain and physical impairment in a large segment of the population. The traditional treatment algorithm progresses from conservative modalities to nonsurgical options to surgical intervention. Surgical intervention often provides reliable pain relief but not all patients are surgical candidates and there are some patients who prefer not to have surgery. Cooled radio frequency ablation (C-RFA) is a treatment with the potential to provide pain relief for patients who no longer benefit from noninvasive modalities and who desire an alternative to surgery. The objective of this review article is to provide the rationale, available evidence, indications, and outcomes associated with C-RFA for the treatment of chronic knee OA. A total of eight reports that use C-RFA in the treatment of chronic knee pain were identified and analyzed. There were two prospective trials, one retrospective cohort study, and five case reports or case series. C-RFA is an emerging procedure with encouraging early results; however, additional long-term prospective clinical trials are necessary to further characterize how C-RFA can best be used to treat chronic knee pain.

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“…Rajiv et al [24] administered unilateral or bilateral cRFA in four patients with pain relief of 80% from the diagnostic genicular nerve block before the ablation, and reported improvements by 80-100% in knee pain, function and using analgesic drugs at six to 12-month follow up in all patients. Mc Cormick et al [25] showed clinically significant improvement concerning pain, physical function, and psychologic function up to approximately six months in about half of the patients who underwent genicular nerve cRFA for chronic pain associated with knee osteoarthritis. The authors underlined that a prognostic genicular nerve block used as a threshold of 50% pain relief for conformity of 1 mL local anesthetic volume and subsequent cRFA in each injection region did not improve the rate of treatment success.…”

Section: Discussionmentioning

confidence: 99%

Fluoroscopy -guided genicular nerves pulsed radiofrequency for chronic knee pain treatment

Arıcan

Hacıbeyoğlu

Sert

et al. 2019

Agri

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Objectives: The primary objective of this study was to investigate the effects of Pulsed RF application in the genicular nerve on pain and function in patients with osteoarthritis (OA) and its side effects. Methods: This study was conducted between February 2018 and June 2018. Patients who were previously administered diagnostic blocks were evaluated a day later; a drop of at least 50% in numeric pain scores was considered a positive response, and these patients were included in the Pulsed RF neurotomy procedures. Radiofrequency (RF) cannula was advanced towards targeted nerves under the guidance of fluoroscopy. RF lesions were created by applying Pulsed RF treatment to the three genicular nerves three times with five minutes intervals at 42 °C using NT1000 RF Generator. Following the Pulsed RF application, 2 mL 0.5% bupivacaine was injected into each genicular nerve as an anesthetic agent. VAS, pain DETECT scores, WOMAC scores were evaluated preoperative baseline and postprocedure weeks 1, 4, and 12. Patient Global Impression of Change (PGIC) score was evaluated postprocedure weeks 12. Results: This study included 20 patients who were administered genicular nerve Pulsed RF. The mean age was 55.2±3.24 years, and F/M ratio was 12/8. Compared to the pre-procedure period, patients' pain and function evaluation, WOMAC and VAS values decreased by approximately 50% at the end of the 12th week. No side effect was observed in any patients. Conclusion: Our findings suggest that Pulsed RF neurotomy of the genicular nerves is an efficient and safe treatment method for patients with chronic knee osteoarthritis.

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A Prospective Randomized Trial of Prognostic Genicular Nerve Blocks to Determine the Predictive Value for the Outcome of Cooled Radiofrequency Ablation for Chronic Knee Pain Due to Osteoarthritis

Cited by 90 publications

References 38 publications

Radiofrequency techniques to treat chronic knee pain: a comprehensive review of anatomy, effectiveness, treatment parameters, and patient selection

Radiofrequency techniques to treat chronic knee pain: a comprehensive review of anatomy, effectiveness, treatment parameters, and patient selection

Cooled Radio Frequency Ablation for the Treatment of Osteoarthritis-Related Knee Pain: Evidence, Indications, and Outcomes

Fluoroscopy -guided genicular nerves pulsed radiofrequency for chronic knee pain treatment

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