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Current versus revised anatomical targets for genicular nerve blockade and radiofrequency ablation: evidence from a cadaveric model
  1. Loïc Fonkoue1,2,
  2. Catherine Wydemans Behets1,
  3. Arnaud Steyaert3,4,
  4. Jean-Eric Kouame Kouassi2,
  5. Christine Detrembleur2,
  6. Bernard LePolain De Waroux3 and
  7. Olivier Cornu2,5
  1. 1Department of Morphology, Experimental and Clinical Research Institute, Université catholique de Louvain, Brussels, Belgium
  2. 2Neuro-Musculo-Skeletal Department, Experimental and Clinical Research Institute, Universite catholique de Louvain, Brussels, Belgium
  3. 3Department of Anesthesiology and Pain Medicine, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
  4. 4Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
  5. 5Department of Orthopedics and Trauma, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
  1. Correspondence to Dr Loïc Fonkoue, Department of Morphology, Experimental and Clinical Research Institute, Université catholique de Louvain, Brussels 1200, Belgium; loic.fonkoue{at}uclouvain.be

Abstract

Introduction Recent studies have proposed revised anatomical targets to improve accuracy of genicular nerve (GN) radiofrequency ablation (RFA). This study aims to compare the accuracy of classical and revised techniques for fluoroscopic-guided GN-RFA in cadaveric models.

Materials and methods Fourteen knees from seven fresh frozen human cadavers were included in this study. For each cadaver, RF cannulas were placed to capture the GN according to the current targets in one knee, and the revised targets in the other knee, randomly. The stylet was removed from the cannula, plunged into non-diffusible black paint, and reintroduced entirely in the cannula, to create a limited black spot on the tissues at the top of the active tip. Anatomical dissection was performed, and the accuracy of both techniques was compared.

Results The mean distance from the top of the active tip to the nerve was significantly lower with revised than current targets for the superior-medial GN (0.7 mm vs 17.8 mm, p=0.01) and the descending branch of the superior-lateral GN (3.7 mm vs 24.4 mm, p=0.02). In both superior-medial GN and superior-lateral GN, the accuracy rate was higher with revised than current targets: 100% vs 0% and 64% vs 35%, respectively. In addition, the accuracy of revised targets for the recurrent fibular nerve and the infrapatellar branch of saphenous nerve was 100%.

Conclusion This study demonstrates that the revised targets are more accurate than the current targets for GN-RFA.

  • radiofrequency ablation
  • pain medicine
  • anatomy
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Footnotes

  • Contributors LF: conception and design, cadaveric dissections, data collection and analysis, manuscript writing. CB: conception and design, cadaveric dissections, manuscript revision. AS: conception and design, manuscript revision. J-EKK: assistance in cadaveric dissections, manuscript revision. CD: data analysis, manuscript revision. BLPDW: conception and design, manuscript revision. OC: project manager, conception and design, 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.

  • 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.

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