# Ultrasound-guided genicular nerve radiofrequency ablation: A revised protocol illustrated through high-definition video

## TL;DR

This paper introduces a high-definition video protocol for ultrasound-guided knee nerve ablation to manage chronic knee pain, aiming to improve training and outcomes.

## Contribution

A revised, video-based ultrasound-guided protocol for genicular nerve radiofrequency ablation is presented to enhance procedural clarity and training.

## Key findings

- High-definition videos illustrate a revised protocol for targeting specific knee nerves using ultrasound guidance.
- Individualized approaches based on patient-specific pain localization improve outcomes and reduce discomfort.
- Video-based literature on genicular nerve ablation is limited, highlighting a need for more educational resources.

## Abstract

Radiofrequency ablation (RFA) of the knee joint may be an effective therapeutic option for the management of chronic knee pain. Accurate anatomical knowledge is essential for optimizing the precision and outcomes of the procedure. The innervation of the knee joint is complex. Ultrasound (US) guidance offers a widely accessible method for targeting sensory nerves. Given the limited availability of high-quality video literature on knee RFA, we developed an educational video illustrating an extensive revised ultrasound-guided protocol.

To present a video-based description of a revised ultrasound-guided RFA protocol for the knee, targeting specific nerves by anatomical quadrant: superomedial quadrant (Video 1)– medial branch of the NVI, SMGN; inferomedial quadrant (Video 2) – IMGN; superolateral quadrant (Video 3) – lateral branch of the NVI, SLGN; and inferolateral quadrant (Video 4) - RFN.

Seven patients with advanced knee osteoarthritis, unresponsive to conservative treatment, underwent selective RFA of either the medial or lateral quadrants, based on the distribution of their pain. The procedures were recorded in high definition and annotated to serve educational purposes.

The video-based illustrations presented may enhance procedural clarity and facilitate clinician training. Due to the time consuming and potential for pain associated with the procedure described, targeting all nerves may be not appropriate in every patient. An individualized approach, tailoring the selection of targets based on patient-specific characteristics and localization of pain is likely more optimal.

•Video-based literature on genicular nerve ablation remains limited.•This article presents a high-resolution, picture-in-picture video protocol for nerve targeting.•Radiofrequency ablation of the knee is a complex and uncomfortable procedure.•Radiofrequency ablation of the knee protocol should be tailoredto improve outcomes and reduce discomfort.

Video-based literature on genicular nerve ablation remains limited.

This article presents a high-resolution, picture-in-picture video protocol for nerve targeting.

Radiofrequency ablation of the knee is a complex and uncomfortable procedure.

Radiofrequency ablation of the knee protocol should be tailoredto improve outcomes and reduce discomfort.