Emperor’s nakedness exposed: unmasking fairytales for genicular nerve radiofrequency ablation in knee osteoarthritis

Pain in Osteoarthritis: Driven by Intrinsic Rather Than Extrinsic Joint Afferents and Why This Should Impact Treatment

“…This minimally invasive procedure was rapidly adopted in the belief that it is a simple, painless and comparatively successful approach to the relief of OA of the knee [27,28]. The reliability of this belief, however, has been challenged recently with the suggestion that despite this (single) RCT, the numerous optimistic follow-up reports may largely reflect wishful thinking by patient and physician, i.e., placebo [29]. Research is ongoing to test this and to determine whether lesioning a larger fraction of the genicular nerves might yield better and more reliable results.…”

“…The answer matters. If Cohen et al's [29] critique that lesioning (these) 3 genicular nerves is not enough, their proposal to attack a larger number is indeed likely to result in better pain relief as this will surely increase the extent of subchondral bone denervation. However, the simultaneous massive denervation of the knee's extrinsic innervation might risk joint instability, painful genicular nerve-end neuromas, or even a Charcot joint.…”