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  • Feasibility of an ultrasound-guided approach to radiofrequency ablation of the superolateral, superomedial and inferomedial genicular nerves: a cadaveric study

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Chronic and Interventional Pain
Feasibility of an ultrasound-guided approach to radiofrequency ablation of the superolateral, superomedial and inferomedial genicular nerves: a cadaveric study
  1. Bert Vanneste1,
  2. Joanna Tomlinson2,3,
  3. Matthias Desmet1 and
  4. Andrzej Krol4
  1. 1 Department of Anesthesia, AZ Groeninge, Kortrijk, Belgium
  2. 2 Department of Anatomy, University of Otago, Dunedin, New Zealand
  3. 3 Department of Anatomical Sciences, St George's, University of London, London, UK
  4. 4 Department of Anesthesiology and Pain Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr Bert Vanneste, Department of Anesthesia, AZ Groeninge, Kortrijk 8500, Belgium; bert.vanneste{at}azgroeninge.be

Abstract

Introduction Genicular nerve radiofrequency (RF)denervation appears to be a promising treatment for knee pain in patients with degenerative osteoarthritis of the knee, when candidates are not suitable for arthroplasty. This study aimed to assess the accuracy and reliability of ultrasound-guided placement of RF cannulas in cadavers for genicular nerve treatment, by measuringthe needle-to-nerve proximity.

Materials and methods Five soft-fix human cadavers were included in this study, totaling 10 knees (meanage 93.8 years). Using the ultrasound-guided technique,which we have described previously, RF cannulas were directed toward the superolateral genicular nerve(SLGN), the superomedial genicular nerve (SMGN) and the inferomedial genicular nerve (IMGN). Indocyaninegreen (ICG) dye (0.1 mL) was infiltrated. An anatomical dissection was performed and the distance from the center of the ICG mark to the genicular nerve concerned was measured.

Results The mean distances from the center of the ICG mark to the SLGN, SMGN and IMGN were 2.33 mm(range 0.00–6.05 mm), 3.44 mm (range 0.00–10.59mm) and 1.32 mm (range 0.00–2.99 mm), respectively. There was no statistical difference in distances from the center of the ICG mark to the targeted nerve between the different nerves (p=0.18).

Conclusion The results of this study demonstrate that ultrasound-guided treatment of the genicular nerves is feasible. However, for RF ablations, there are some limitations, which mostly can be overcome by using appropriate RF ablation settings.

  • anatomy
  • denervation
  • genicular
  • knee

https://doi.org/10.1136/rapm-2019-100381

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    Footnotes

    • Contributors AK conceived the original idea of this trial and supervised the project. AK and BV did the literature research on the clinical aspect of genicular nerve denervation. JT performed the literature research on the anatomy of the genicular nerves. The protocol was written by BV. Planning, execution and data collection of the experiment were carried out by BV and JT. MD performed the statistical analysis. BV took the lead in writing the manuscript. All authors equally provided critical feedback and helped shape the research, analysis and manuscript.

    • 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 The authors obtained approval from the local ethics committee (St. George’s Research Ethics Committee, approval number SGREC17.0030).

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

    • Data availability statement Data are available upon reasonable request.