Pulsed Radiofrequency of the Composite Nerve Supply to the Knee Joint as a New Technique for Relieving Osteoarthritic Pain: A Preliminary Report

Abstract

We report a new technique for pulsed radiofrequency (PRF) of the entire nerve supply of the knee as an option in treating osteoarthritis (OA) of knee. We targeted both sensory and motor nerves supplying all the structures around the knee: joint, muscles, and skin to address the entire nociception and stiffness leading to peripheral and central sensitization in osteoarthritis. Ten patients with pain, stiffness, and loss of function in both knees were treated with ultrasonography (USG) guided PRF of saphenous, tibial, and common peroneal nerves along with subsartorial, peripatellar, and popliteal plexuses. USG guided PRF of the femoral nerve was also done to address the innervation of the quadriceps muscle. Assessment of pain (Numerical Rating Scale [NRS], pain DETECT, knee function [Western Ontario and McMaster Universities Osteoarthritis Index- WOMAC]) were documented pre and post PRF at 3 and 6 months. Knee radiographs (KellgrenLawrence [K-L] grading) were done before PRF and one week later. All the patients showed a sustained improvement of NRS, pain DETECT, and WOMAC at 3 and 6 months. The significant improvement of patellar position and tibio-femoral joint space was concordant with the patient’s reporting of improvement in stiffness and pain. The sustained pain relief and muscle relaxation enabled the patients to optimize physiotherapy thereby improving endurance training to include the daily activities of life. We conclude that OA knee pain is a product of neuromyopathy and that PRF of the sensory and motor nerves appeared to be a safe, effective, and minimally invasive technique. The reduction of pain and stiffness improved the knee function and probably reduced the peripheral and central sensitization. Key words: Osteoarthritis, knee pain, stiffness, knee innervation, femoral nerve supply, Hilton’s law, peripheral sensitization, pulsed radiofrequency treatment of nerves to knee joint

Comparison of Efficacy among Three Radiofrequency Ablation Techniques for Treating Knee Osteoarthritis: A Systematic Review and Meta-Analysis

“…Two records were not published in English or Chinese. Finally, a total of 20 eligible articles were included in our meta-analysis [ 7 , 9 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

Anatomical and Technical Considerations of "Dual Subsartorial Block" (DSB), A Novel Motor-sparing Regional Analgesia Technique for Total Knee Arthroplasty

“…(Figure 2) It is formed by an infrapatellar branch from the SN, anterior division of obturator nerve, medial femoral cutaneous nerve, and NVM. It supplies the skin over the anteromedial aspect of the knee joint, retinaculum, collateral ligaments, and capsule of the knee joint [15].…”

Clinical efficacy of repeated intra‑articular pulsed radiofrequency for the treatment of knee joint pain and its effects on inflammatory cytokines in synovial fluid of patients

“…Erdem and Sir ( 12 ) investigated the effects of ultrasound-guided knee radiofrequency treatment on knee joint pain in patients with severe knee OA or patients who underwent knee arthroplasty and indicated that perceived pain and disability in the knee medial nerves were relieved after the treatment. Relevant studies have confirmed that pulsed radiofrequency treatment for the knee joint, a novel technique for relieving pain in OA, is able to reduce pain, relax the muscles and improve knee function ( 13 ). Such injuries stimulate large increases in the levels of catabolic species, which contribute to progressive cartilage destruction in the synovial fluid ( 14 ).…”