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Evaluation of nerve capture using classical landmarks for genicular nerve radiofrequency ablation: 3D cadaveric study
  1. John Tran1,
  2. Philip Peng2 and
  3. Anne Agur1
  1. 1 Surgery (Division of Anatomy), University of Toronto, Toronto, Ontario, Canada
  2. 2 Anesthesia, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
  1. Correspondence to Dr John Tran, Surgery (Division of Anatomy), University of Toronto, Toronto, ON M5S, Canada; johnjt.tran{at}


Background and objectives Radiofrequency (RF) denervation of the superolateral genicular nerve (SLGN), superomedial genicular nerve (SMGN) and inferomedial genicular nerve (IMGN) is commonly used to manage chronic knee joint pain. However, knowledge of articular branches captured, using classical landmarking techniques, remains unclear. In order to enhance and propose new RF procedures that conceivably capture a greater number of articular branches, more detailed cadaveric investigation is required. The objectives were to (1) determine which articular branches are captured or spared using classical landmarking techniques, and (2) evaluate the anatomical feasibility of classical landmarking techniques using three-dimensional (3D) modeling technology.

Methods Ultrasound-guided classical superolateral/superomedial/inferomedial landmarking techniques were used to position RF cannulae in five specimens. The articular branches, bony and soft tissue landmarks, and cannula tip position, were meticulously dissected, digitized and modeled in 3D. Simulated lesions were positioned at the cannula tip, on the 3D models, to determine which articular branches were captured or spared. Capture rates of articular branches were compared.

Results In all specimens, classical superolateral/superomedial techniques captured the transverse deep branches of SLGN and SMGN, and articular branches of lateral and medial nerve to vastus intermedius, while sparing distal branches of SLGN/SMGN. The inferomedial technique captured anterior branches of IMGN while sparing the posterior and inferior branches.

Conclusions This study provides anatomical evidence supporting the effectiveness of classical landmarking for genicular nerve ablation; however, each technique resulted in sparing of articular branches. The extensive innervation of the knee joint suggests the use of supplementary landmarks to improve capture rates and potentially patient outcomes.

  • chronic pain
  • pain management
  • lower extremity
  • ultrasonography

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  • Presented at Interim data from this work was presented at the 2020 American Association of Clinical Anatomists Annual Meeting, 15–19 June 2020.

  • Contributors JT, PP, AA contributed to the experimental design, data acquisition, analysis of data, drafting and revising the manuscript critically for important intellectual content.

  • 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 PP received equipment support from Sonosite Fujifilm Canada. AA is an Anatomy Faculty with Allergan Academy of Excellence.

  • Patient consent for publication Not required.

  • Ethics approval This cadaveric study was approved by the University of Toronto Health Sciences Research Ethics Board (#27210).

  • 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. All data relevant to the study are included in the article.