Please confirm that an ethics committee approval has been applied for or granted: Not relevant

Background and Aims The use of radiofrequency techniques targeting genicular nerves has become a viable option for managing refractory knee pain. Radiofrequency ablation(RFA) and pulsed radiofrequency(PRF) applied to peripheral nerves have demonstrated efficacy in pain reduction. Technical challenges such as charred tissue formation and optimal electrode placement present hurdles to achieving optimal outcomes. A novel approach, CRFA offers the potential for more comprehensive denervation. The utilization of larger, spherical lesion shapes minimizes missing target nerves and allows for greater flexibility in approach angles. There is a potential correlation between lesion size and the magnitude and duration of pain relief. We present a patient with chronic refractory knee pain in whom CRFA provided long-term pain relief.

Methods A 65-year-old woman suffering from chronic refractory knee pain unresponsive to multiple treatments, including analgesics, physical therapy and bilateral knee replacement. Five left knee PRF(42oC;600’) yielded temporary relief, while minor improvement followed right knee PRF and three RFA(80oC;180’) sessions (2016-2021). Two CRFA(60oC;150’) sessions were performed on the left knee and one on the right (2022-2024).

Results CRFA led to a dramatic decrease in pain (VAS 9-10/10 to 0/10 at rest and 2/10 at walking). Significant and sustained pain relief for more than a year after each treatment, with no reported complications.

Conclusions Our findings support CRFA as a safe and effective treatment modality for knee pain management, with superior long-term outcomes compared to traditional RF techniques. However, recent literature highlights limited and conflicting evidence, necessitating further clinical trials with extended follow-ups to validate the efficacy and safety profile of CRFA.