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Accuracy of fluoroscopic-guided genicular nerve blockade: a need for revisiting anatomical landmarks
  1. Loïc Fonkoue1,2,
  2. Catherine Wydemans Behets1,
  3. Arnaud Steyaert3,4,
  4. Jean-Eric Kouame Kouassi2,
  5. Christine Detrembleur2,
  6. Bernard Le Polain De Waroux3 and
  7. Olivier Cornu2,5
  1. 1 Department of Morphology, Experimental and Clinical Research Institute, Universite catholique de Louvain, Brussels, Belgium
  2. 2 Neuro-Musculo-Skeletal Department (NMSK), Experimental and Clinical Research Institute, Université catholique de Louvain, Brussels, Belgium
  3. 3 Department of Anesthesia and Pain Medicine, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
  4. 4 Institute of Neuroscience (IONS), Universite catholique de Louvain, Brussels, Belgium
  5. 5 Department of Orthopedics and Trauma, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
  1. Correspondence to Dr Loïc Fonkoue, Department of Morphology, Experimental and clinical research institute, Universite catholique de Louvain, Brussels 1348, Belgium; loic.fonkoue{at}uclouvain.be

Abstract

Background and objectives Genicular nerve blockade (GNB) and radiofrequency ablation (RFA) have recently emerged as treatment options for patients with chronic knee pain. However, an increasing number of anatomical studies and systematic reviews concluded that the anatomical basis for needle placement was unclear, incomplete and somewhat inaccurate. This study was designed to assess the accuracy of updated anatomical landmarks for fluoroscopy-guided blockade of the consistent genicular nerves in a cadaveric model.

Methods Based on a comprehensive review of recent anatomical studies and prior dissection of 21 fresh cadaver knees, we defined bony landmarks with high likelihood of successful ablation of the five consistent genicular nerves (GN). We tested the accuracy of GNBs using the above-stated anatomical landmarks in 10 intact fresh cadaveric knees. Needle placement was guided by fluoroscopy and 0.5 mL of 0.1% methylene blue was injected at the site of each nerve. The knees were subsequently dissected to assess the accuracy of the injections. If the nerve was dyed with blue ink, the placement was considered accurate.

Results The accuracy of our injections was 100% for the superior medial genicular nerve, inferior medial GN, infrapatellar branch of saphenous nerve and recurrent fibular nerve. The superior lateral GN was dyed in 90% of specimens.

Conclusion This study provides physicians with precise anatomical landmarks for the five consistent GN for fluoroscopic-guided GNB. Our revised technique, which targets more nerves with increased accuracy, could potentially lead to improved therapeutic benefits on chronic knee pain.

  • Anatomy
  • Interventional Pain Management
  • Pain Medicine
  • Radiofrequency Ablation
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Footnotes

  • Contributors LF, CB and OC contributed to the conception and design. LF and CB contributed to the cadaveric dissections, data collection and analysis. AS and BLPDW contributed to the data analysis. JEKK provided assistance in cadaveric dissections. LF contributed to the manuscript writing. AS, BLPDW, JEKK, CB and OC contributed to the manuscript revision. OC is the project manager.

  • 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 Ethics approval was received from the Research Ethic Board for health sciences of the Université Catholique de Louvain.

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

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