Korean J Pain.  2024 Jul;37(3):275-279. 10.3344/kjp.24021.

Optimizing genicular nerve chemical ablation

• Rocha-Romero A
• Ng TKT
• Lam KHS

• KMID: 2557731
• DOI: http://doi.org/10.3344/kjp.24021

Figure

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  Fig. 1 Medial branch of nerve to vastus intermedius. Fig. 1A indicates the probe position. Fig. 1B is transverse view of ultrasound image. Fig. 1C is coronal view. Note the importance of bi-plane confirmation of this final needle position. The needle tip is at around 30% of the anterior cortex of femoral shaft. MFEC: medial femoral epicondyle, Asterisk: final needle position with phenol, Blue arrows: needle.

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  Fig. 2 Superomedial genicular nerve. Fig. 2A indicates the probe position. Fig. 2B is transverse view of the adductor tubercle (AT) as the landmark. Fig. 2C showing that the actual plane of needle insertion is slightly proximal to the AT until the AT becomes less sharp. This modification can reduce the risk of adductor tendon irritation by phenol. Asterisk: final needle position with phenol, Blue arrows: needle.

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  Fig. 3 Lateral branch of nerve to vastus intermedius. Fig. 3A indicates the probe position. Fig. 3B is transverse view of ultrasound image. Fig. 3C is coronal view. It is a mirror image of that of the medial branch of nerve to vastus intermedius. LFEC: lateral femoral epicondyle, Asterisk: final needle position with phenol, Blue arrows: needle.

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  Fig. 4 Superolateral genicular nerve and anterior branch of common peroneal nerve. Fig. 4A indicates the probe position. Fig. 4B is transverse view of ultrasound image for the superolateral genicular nerve. Fig. 4C showing that the needle trajectory is redirected to the posterior cortex for the anterior branch of common peroneal nerve, this distal branch is not depicted in the diagram because is posterior. The landmark is the lateral femoral epicondyle (LFEC). Blue arrows: needle, Asterisk: final needle position with phenol.

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  Fig. 5 Recurrent fibular nerve. Fig. 5A indicates the probe position. Fig. 5B is doppler image of transverse view depicting the anterior tibial recurrent artery. Fig. 5C showing that the needle trajectory is along the bony surface of the lateral tibial condyle (LTC) to minimize the chance of phenol extravasation to the superficial structure, particularly skin. The final needle position is around the midway of the LTC. FH: fibular head, Asterisk: final needle position with phenol, Blue arrows: needle, (+): anterior tibiofibular ligament, Red dot: anterior tibial recurrent artery.

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  Fig. 6 Inferomedial genicular nerve. Fig. 6A indicates the probe position. Fig. 6B is transverse view of ultrasound image with needle tip around 50% of the anterior cortex of tibial shaft. Fig. 6C is coronal view, showing needle tip underneath the medial collateral ligament (MCL). Inferomedial genicular nerve. Note the dual-plane confirmation of the final needle position. MTC: medial tibial condyle, Asterisk: final needle position, Blue arrows: needle.

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