Genicular Neurotomy
Genicular Neurotomy (aka ablation) is a brand new, innovative treatment option for treating knee pain without surgery. This highly advanced procedure is on the absolute cutting edge of medicine. By selectively applying a sophisticated type of radio wave to the nerves surrounding the knee (the genicular nerves), one can effectively relieve pain in the knee from any number of causes:
- Osteoarthritis (OA)
- Chronic Knee Pain
- Degenerative Joint Disease
- Total Knee Replacement (before or after)
- Partial Knee Replacement (before or after)
- Patients unfit for knee replacement
- Patients who want to avoid a knee replacement
While surgery is considered to be the accepted treatment option for patients with advanced joint disease, many individuals have comorbidities that may prevent them from being an appropriate surgical candidate. Others may simply want to avoid surgery, as they may be unable to take off the necessary time from work for the procedure and post-operative recovery period. In these cases, radiofrequency neurotomy of the genicular nerves is a safe and successful alternative to joint replacement.
Despite the general efficacy of knee replacements, there are those with pain that persists after surgery. Traditionally in these unfortunate cases, patients had few options if any that did not involve additional surgery that was rarely successful. With advent of genicular nerve neurtomy, patients can look forward to pain relief without any further surgeries.
Anatomy
The innervation of the knee is comprised of branches of femoral, saphenous, common peroneal, tibial and obterator nerves. Small, articular branches of these nerves, known as the genicular nerves, surround the knee and provide innervation to the joint.
Genicular nerves consist of 5 relevant branches:
- Superior lateral (SL)
- Superior medial (SM)
- Inferior lateral (IL)
- Inferior medial (IM)
- Recurrent tibial genicular nerve .
Radiofrequency Neurotomy, when applied to the genicular nerves of the knee, can provide a therapeutic alternative to surgery in effectively treating chronic knee pain. The targets in this treatment modality are the SL, SM and IM. These 3 branches make ideal targets for the procedure, as they are easily accessible by percutaneous approach under fluoroscopic guidance – they lie on the surface of bone at the confluence of the femur with the medial and lateral epicondyles and the confluence of the tibia with the medial epicondyle.
Procedure
This procedure is performed in 2 phases:
- Diagnostic Genicular Nerve Block – this procedure consists of placing a small amount of a local anesthetic, like Lidocaine or Bupivacaine, on the genicular nerves to test the patient’s response and see if there is sufficient enough relief in the knee to justify performing a therapeutic neurotomy
- Genicular Nerve Ablation – this is the therapeutic portion of the treatment whereby the physician will perform a radiofrequency ablation (RFA) of the genicular nerves, thus alleviating pain to the knee and restoring function.
- Both portions of the procedure are performed as an outpatient under direct fluoroscopic guidance.
