Open AccessIs Genicular Nerve Radiofrequency Ablation Safe? A Literature Review and Anatomical Study
Author(s) -
Phuong Uyen Le Do
Publication year - 2016
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2019.19.e679
Subject(s) - medicine , radiofrequency ablation , surgery , cadaveric spasm , patella , neurovascular bundle , anatomy , ablation
Genicular nerve radiofrequency ablation (RFA) has recently gained popularity as anintervention for chronic knee pain in patients who have failed other conservative orsurgical treatments. Long-term efficacy and adverse events are still largely unknown.Under fluoroscopic guidance, thermal RFA targets the lateral superior, medial superior,and medial inferior genicular nerves, which run in close proximity to the geniculararteries that play a crucial role in supplying the distal femur, knee joint, meniscus,and patella. RFA targets nerves by relying on bony landmarks, but fails to providevisualization of vascular structures. Although vascular injuries after genicular nerveRFA have not been reported, genicular vascular complications are well documented inthe surgical literature. This article describes the anatomy, including detailed cadavericdissections and schematic drawings, of the genicular neurovascular bundle. Thepresent investigation also included a comprehensive literature review of genicularvascular injuries involving those arteries which lie near the targets of genicular nerveRFA. These adverse vascular events are documented in the literature as case reports.Of the 27 cases analyzed, 25.9% (7/27) involved the lateral superior genicular artery,40.7% (11/27) involved the medial superior genicular artery, and 33.3% (9/27)involved the medial inferior genicular artery. Most often, these vascular injuries resultin the formation of pseudoaneurysm, arteriovenous fistula (AVF), hemarthrosis, and/or osteonecrosis of the patella. Although rare, these complications carry significantmorbidities. Based on the detailed dissections and review of the literature, ourinvestigation suggests that vascular injury is a possible risk of genicular RFA. Lastly,recommendations are offered to minimize potential iatrogenic complications.Key words: Genicular nerve, genicular artery, radiofrequency ablation, genicularvascular injury, knee osteoarthritis, patella injury