Korean J Pain.  2022 Oct;35(4):447-457. 10.3344/kjp.2022.35.4.447.

Predictive factors associated with successful response to utrasound guided genicular radiofrequency ablation

• Kose SG
• Kose HC
• Celikel F
• Akkaya OT

• KMID: 2533985
• DOI: http://doi.org/10.3344/kjp.2022.35.4.447

Abstract

Background
Ultrasound-guided genicular nerve radiofrequency (RF) procedures are of interest in the management of chronic knee pain. A wide variety of demographic, clinical, and procedural characteristics can affect treatment success. This study aimed to determine predictive factors to provide superior treatment outcomes.
Methods
The demographic, clinical, and technical data of patients who received genicular nerve RF for knee pain between September 2016 and September 2021 were evaluated. A positive outcome was defined as at least 50% pain relief on a pain score for at least 6 months. Logistic regression analysis was performed to determine the factors associated with a successful response to genicular RF.
Results
Among 206 patients who underwent genicular RF, 62% of the patients reported successful outcomes at 6 months. In the multivariate model, targeting 5 nerves (odds ratio [OR], 6.184; 95% confidence interval [CI], 2.291–16.690; P < 0.001) was the most significant predictor of successful outcomes. Multivariable logistic regression analysis showed that prognostic genicular nerve block with a 50% cut-off value (OR, 2.109; 95% CI, 1.038–4.287; P = 0.039), no opioid use (OR, 2.753; 95% CI, 1.405–5.393; P = 0.003), and depression (OR, 0.297; 95% CI, 0.124–0.713; P = 0.007) were the predictive factors significantly associated with response to genicular RF.
Conclusions
Clinical and technical factors associated with better treatment outcomes were ultimately targeting more nerves, performing prognostic block, no opioid use, and no depression. These results are expected to be considered when selecting patients for genicular RF.

Keyword

Chronic Pain; Knee; Nerve Block; Outcome Assessment; Health Care; Pain; Prognosis; Radiofrequency Ablation; Treatment Outcome; Ultrasonography; Interventional

Figure

• 

  Fig. 1 Transducer placement and ultrasound images with radiofrequency cannula for SMGN (A, B), SLGN (C, D), and IMGN (E, F). White dashed arrows indicate the needle trajectory. SMGN: superior medial genicular nerve, SLGN: superior lateral genicular nerve, IMGN: inferior medial genicular nerve, MFC: medial femoral condyle, LFC: lateral femoral condyle, MTC: medial tibial condyle, MCL: medial collateral ligament.

• 

  Fig. 2 Transducer placement and ultrasound images with radiofrequency cannula for IPBSN (A, B) and RFN (C, D). White dashed arrows indicate the needle trajectory. Yellow stars indicate the patella apex and tibial tuberosity. IPBSN: infrapatellar branch of the saphenous nerve, RFN: recurrent fibular nerve, MTC: medial tibial condyle, P: patella.

• 

  Fig. 3 Flowchart of the study. RFA: radiofrequency ablation.

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