Ultrasound-guided genicular nerve radiofrequency treatment: prospective randomized comparative trial of a 3-nerve protocol versus a 5-nerve protocol

Abstract

Abstract Objectives Genicular nerve radiofrequency procedures increasingly are being performed to treat chronic pain due to knee osteoarthritis. Targeting additional sensory nerves and improving target identification by using ultrasound guidance could improve treatment success. The aim of this study was to compare the effectiveness of targeting only the traditional genicular nerves versus targeting the traditional genicular nerves plus 2 additional sensory nerves in ultrasound-guided genicular nerve radiofrequency procedures in patients with chronic knee osteoarthritis. Methods A total of 80 patients were randomized into 2 groups. Patients in the 3-nerve-targeted group received a genicular radiofrequency procedure in which the traditional genicular nerves were targeted: the superior lateral, superior medial, and inferior medial nerves. The 5-nerve-targeted group received a genicular radiofrequency procedure in which the recurrent fibular and infrapatellar branches of the saphenous nerve were targeted in addition to the traditional genicular nerves. The numeric rating scale, Short Form-36, Western Ontario and McMaster Universities Arthritis Index, Quantitative Analgesic Questionnaire, and patient satisfaction were evaluated before treatment, at week 1 after treatment, and at months 1, 3, and 6 after treatment. Results Both techniques provided significant pain reduction and functional improvement up to 6 months after the procedure (P < .05). The 5-nerve-targeted group showed significant improvement with regard to the numeric rating scale, Western Ontario and McMaster Universities Arthritis Index total, and Short Form-36 score compared with the 3-nerve-targeted group at each follow-up point. No differences in the Quantitative Analgesic Questionnaire or patient satisfaction scores were observed between the groups. Conclusions The ultrasound-guided 5-nerve-targeted technique is a safe method and a more effective therapeutic procedure than the traditional 3-nerve-targeted technique for chronic knee osteoarthritis. Trial registration www.ClinicalTrials.gov ID: NCT05073887.