Assistant Professor SIU School of Medicine Springfield, Illinois
Abstract Title: Genicular Nerve Radiofrequency Ablation use in varied knee pathologies; A case series
Background: Chronic pain is a highly disabling condition that can have significant financial, physical and mental repercussions in the society as a whole and to the individual sufferer. Osteoarthritis is the most prevalent disabling knee condition that contributes to the above burden, with a prevalence of 365 million people. Multiple modalities of treatment are attempted to provide relief in knee OA. Other causes of knee pain, remote traumas, ligament tears can also lead to pathological loading of the knees that can ultimately lead to knee osteoarthritis. Here we discuss the use of genicular nerve radiofrequency ablation, an upcoming novel technique of treatment of knee pain in two patients with the common crux of knee pain but caused by different pathologies.
Purpose/Objectives: The primary goal of this abstract is to provide first person experience from out center of the efficacy and use of genicular nerve RFAs in knee arthralgias arising from different conditions. Genicular RFAs can be used as an adjuvant to total knee replacements and exploration arthroscopic procedures to help the patient undergo vigorous physical therapy and conditioning that will ensure long term pain and disability relief.
Methods: This was a case series project that involves two patients in whom genicular nerve RFAs were trialed. Both the patients have varied insults and pathologies that led to the pathological picture of pain and disability. Genicular nerve RFA was trialed after no relief was obtained with multiple modalities of treatment that included medical management, physical therapy and local operative procedures in the form of arthroscopic repairs and total knee replacements
Results: Case 1:
A 46-year-old female with a history of migraines and depression presented with persistent knee pain. She had an anterior cruciate ligament (ACL) tear from a motor vehicle accident 24 years ago, which was repaired. Over the last decade, her right knee pain increased. An X-ray was normal, but an MRI showed an intact ACL graft with an old fragment in the joint. She also had lower back pain due to canal stenosis at L4-L5. Despite treatment with physical therapy, lumbar epidural steroid injections, and medications (Gabapentin, Fentanyl patches, Tylenol), her pain persisted. MRI revealed a lateral meniscus tear and a lateral femoral condylar fracture with loose tibial hardware. She underwent arthroscopy, which revealed and repaired tears in both menisci, but her pain continued. At the interventional pain clinic, a genicular nerve block trial reduced her pain from 8 to 0 on the Numerical Rating Scale (NRS). The pain returned to 6 within a month, so another nerve block was tried, again reducing the pain to 0. Following this success, radiofrequency ablation (RFA) was initiated, providing complete pain resolution for a year. She now receives annual RFA treatments with no adverse effects.
Case 2: An 87-year-old female with right knee osteoarthritis, left knee osteoarthritis with total knee replacement, and left shoulder impingement presented with persistent right knee pain for 3-4 years. She underwent total knee replacement on the right side but continued to experience pain. Evaluations for fractures, dislocations, loose hardware, or infections were negative. Initial treatments with physical therapy and pain medications were ineffective. She was referred to the interventional pain clinic. Previously, genicular nerve blocks on her left knee provided relief, though she didn't proceed to RFA. A trial of right genicular nerve blocks reduced her knee pain from 9 to 0 on the NRS. After a month, her pain returned, and a confirmatory nerve block again reduced her pain from 8 to 0. She then underwent RFA, which resulted in near-complete pain resolution lasting over a year.
Conclusions/Implications for future research and/or clinical care: Genicular nerve radiofrequency ablation procedure is a novel and upcoming technique that has been tried and tested in chronic knee pain secondary to osteoarthritis. While this technique has been less reported in patients with other conditions of chronic knee pain, a trial of such appears to be a fair approach in symptomatic management which will ultimately act as a supplement in preventing disability caused by the pain and encourage good functional activity and physical therapy, ultimately providing the patient with necessary disability free days and quality of life.
