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  • Validation of a new protocol for ultrasound-guided genicular nerve radiofrequency ablation with accurate anatomical targets: cadaveric study

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Original research
Validation of a new protocol for ultrasound-guided genicular nerve radiofrequency ablation with accurate anatomical targets: cadaveric study
  1. Loïc Fonkoue1,2,
  2. Maria Simona Stoenoiu3,
  3. Catherine Wydemans Behets1,
  4. Arnaud Steyaert4,5,
  5. Jean-Eric Kouame Kouassi2,
  6. Christine Detrembleur2 and
  7. Olivier Cornu2,6
  1. 1 Department of Morphology, Experimental and Clinical Research Institute, Universite Catholique de Louvain, Brussels, Belgium
  2. 2 Neuro-Musculo-Skeletal Department, Experimental and Clinical Research Institute, Universite Catholique de Louvain, Brussels, Belgium
  3. 3 Department of Rheumatology, Cliniques Universitaires Saint-Luc, Experimental and Clinical Research Institute, Universite Catholique de Louvain, Brussels, Belgium
  4. 4 Department of Anesthesia and Pain Medicine, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
  5. 5 Institute of Neurosciences, Universite Catholique de Louvain, Brussels, Belgium
  6. 6 Department of Orthopedics and Trauma, Cliniques Universitaires Saint-Luc, Brussels, Belgium
  1. Correspondence to Dr Loïc Fonkoue, Department of Morphology - Experimental and clinical research institute, Universite catholique de Louvain, Brussels, Belgium; loic.fonkoue{at}uclouvain.be

Abstract

Introduction Ultrasound (US)-guided radiofrequency ablation (RFA) of genicular nerves (GNs) is increasingly performed to manage chronic knee pain. The anatomical foundations supporting the choice of original targets for US-guided GN-RFA have been thoroughly improved by recent anatomical studies. Therefore, this study aimed to provide a new protocol with revised anatomical targets for US-guided GN-RFA and to assess their accuracy in a cadaveric model.

Materials and methods Fourteen fresh-frozen cadaveric knees were used. After a pilot study with 4 knees, five consistent nerves were targeted in the other 10 knees with revised anatomical landmarks: superior medial genicular nerve (SMGN), superior lateral genicular nerve (SLGN), inferior medial genicular nerve (IMGN), recurrent fibular nerve (RFN) and the infrapatellar branch of the saphenous nerve (IPBSN). For each nerve, the lumen of radiofrequency (RF) cannula was prefilled with non-diffusible black paint, and then the cannula was inserted at the target site under US guidance. After US verification of correct placement, the stylet was introduced in the cannula to create a limited black mark on the tissues at the top of the active tip. Anatomical dissection was performed to assess for accuracy.

Results The proportion of nerves directly found in contact with the black mark was 7/10, 8/10, 10/10 and 9/10 for the SMGN, SLGN, IMGN and RFN, respectively. The proportions of nerve captured by the theoretical largest monopolar RF lesions were 100% for the SMGN, IMGN and RFN, and IPBSN and 95% for SLGN. The mean distances from the center of the black mark to the targeted nerve were 2.1±2.2 mm, 1.0±1.4 mm, 0.75±1.1 mm and 2.4±4.5 mm for the SMGN, SLGN, IMGN and RFN, respectively.

Conclusion US-guided GN-RFA with revised anatomical targets resulted in accurate capture of the five targeted nerves. This protocol provides precise sensory denervation of a larger panel of nerves, targeting those whose constancy regarding anatomical location has been clearly demonstrated. It is expected to improve the clinical outcomes.

  • pain management
  • ultrasonography
  • chronic pain

https://doi.org/10.1136/rapm-2020-101936

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    Footnotes

    • LF and MSS contributed equally.

    • Contributors LF: conception and design, cadaveric dissections, data collection and analysis, and manuscript writing. MSS: ultrasound procedures and manuscript revision. CWB: conception and design and manuscript revision. AS: conception and design, ultrasound procedures and manuscript revision. J-EKK: manuscript revision. CD: data analysis and manuscript revision. OC: project management, conception and design and manuscript revision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Approval was granted by the institutional ethics committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.