Abstract
Background
Knee osteoarthritis is a leading cause of chronic pain and disability, and many patients have persistent pain despite conservative treatment or are not candidates for arthroplasty. Contemporary anatomical studies show that the classical three-nerve genicular radiofrequency ablation (RFA) model does not adequately reflect the multibranch innervation of the anterior knee capsule, which may limit efficacy. Structured preprocedural planning may help standardize cannula placement, however, its clinical and anatomical validity requires further investigation.
Case Presentation
We report a 53‑year‑old man with Kellgren–Lawrence grade II knee osteoarthritis and chronic refractory anterior knee pain who underwent RFA using this technique. We developed a periosteal multi‑cannula “palisade‑guided” genicular RFA technique that combines a ruler‑based cannula alignment with individualized mathematical preoperative planning. Insertion points are calculated on anteroposterior radiographs using the formula: a = b × tan (α)° where b is the length of the active electrode tip and α is the cortical inclination angle of the femoral and tibial condyles, allowing creation of elongated, overlapping lesions along the medial and lateral femoral condyles and the medial tibial condyle. The procedure was completed without vascular or neurological complications. The patient experienced complete pain relief (VAS 0) from the second postoperative day with full restoration of daily activities, and only mild transient discomfort at puncture sites. Pain remained low during follow‑up (VAS 2 at 3 months, VAS 3 at 6 and 9 months), consistent with sustained clinical regression of symptoms.
Conclusion
This single case suggests that a structured, geometrically guided modification of genicular RFA may be feasible and may provide sustained pain reduction. However, the actual lesion dimensions, degree of target-branch denervation, and functional benefit were not objectively confirmed. Therefore, these preliminary findings should be interpreted cautiously and require validation in anatomical, imaging-based, prospective, and comparative studies.
Keywords: knee osteoarthritis, genicular nerve radiofrequency ablation, palisade technique, periosteal denervation, chronic knee pain
Background
Knee osteoarthritis (OA) is the most common degenerative disease of the musculoskeletal system among elderly and senile individuals.1 The prevalence of this condition in patients over 70 years of age reaches 40% and continues to increase, predominantly among women.2,3 Knee OA is associated with chronic pain, reduced mobility, sleep disturbances, deterioration of psychoemotional status and quality of life, as well as temporary or permanent disability, including in working-age patients.4
Despite the wide range of conservative and invasive treatment options for knee osteoarthritis - including pharmacotherapy (nonsteroidal anti-inflammatory drugs, analgesics, muscle relaxants), physiotherapy, therapeutic exercise, intra-articular injections of corticosteroids, hyaluronic acid, platelet-rich plasma, and surgical treatment up to total knee arthroplasty (TKA) - a substantial proportion of patients continue to experience severe chronic pain and functional limitations.5–8 In addition, some patients have contraindications to arthroplasty, while others develop persistent or recurrent pain following TKA, which has led to growing interest in minimally invasive pain management techniques.
Over the past two decades, radiofrequency ablation (RFA) of the genicular nerves has emerged as an effective and safe treatment option for chronic knee pain associated with osteoarthritis and post -TKA pain syndrome. Randomized controlled trials and meta-analyses have demonstrated significant pain reduction, improvement in functional outcomes assessed by WOMAC and Oxford Knee Score, and a high responder rate with a low incidence of serious adverse events.2,3,9,10 A large updated meta-analysis published in 2023, including 13 randomized controlled trials and 865 patients, reported a significant reduction in pain intensity at all evaluated follow-up points (1–24 weeks), improvement in functional outcomes, and no increase in the rate of adverse events. Nevertheless, the clinical response to RFA remains highly variable. One of the key reasons is the limitation of the classical technique, which targets only three genicular nerves: the superomedial (SMGN), superolateral (SLGN), and inferomedial (IMGN) genicular nerves. Contemporary anatomical evidence indicates that this model does not adequately reflect the complexity of knee joint innervation. According to the anatomical study by Tran et al, sensory innervation of the anterior knee capsule involves at least ten nerve branches, including branches from the femoral nerve (nerves to vastus medialis, lateralis, and intermedius), the recurrent fibular nerve branch, and the infrapatellar branch of the saphenous nerve (Figure 1).11 Moreover, most of these nerve branches course at a minimal depth - less than 1 mm from the periosteum - along the most prominent areas of the femoral and tibial condyles.12 This anatomical arrangement renders the traditional “three-point” monopolar ablation insufficient for complete denervation of nociceptive structures.
Figure 1.
Three-dimensional visualization of knee joint innervation and periarticular nerve branches, including the anterior capsule and medial- and lateral-sided periarticular branches relevant to knee radiofrequency ablation.
Data from a survey conducted by the American Society of Pain and Neuroscience (ASPN), which included 378 specialists, demonstrated substantial variability in clinical practice. While relative consensus exists regarding the three primary target nerves, a temperature setting of 80 °C, and an ablation duration of 90 seconds, considerable discrepancies persist concerning the necessity of diagnostic nerve blocks, the choice of anesthetic agents, the use of corticosteroids and contrast media, needle configuration and diameter, as well as the type of radiofrequency ablation employed (monopolar, cooled, or bipolar). The lack of a standardized treatment protocol is further compounded by the fact that the classical three-nerve model of knee joint innervation is increasingly recognized as an oversimplification.13,14
In this context, particular interest has emerged in techniques capable of providing an broader theoretical lesion coverage, including bipolar and multifocal RFA, as well as the use of a “palisade” ruler configuration (Figure 2), which generates an elongated coagulation field along the osseous surface. Given that articular nerve branches course in close proximity to the periosteum, periosteal multi-cannula ablation may theoretically allow for more comprehensive coverage of nociceptive afferents than focal three-point ablation, although this assumption requires objective anatomical and imaging validation.15,16
Figure 2.
Schematic representation of radiofrequency ablation of the sacroiliac joint using the palisade ruler technique. The parallel cannula arrangement demonstrates formation of an elongated coagulation zone along the osseous surface.
Based on these data, we developed and implemented an a structured, geometrically guided modification of genicular nerve radiofrequency ablation for knee osteoarthritis. The technique incorporates the use of the “palisade” ruler (author’s certificate No. 55600),17 periosteal placement of electrodes in three anatomical zones, and mathematical preoperative planning of needle insertion points based on the individual angles of the cortical surfaces of the femoral and tibial condyles. This approach is intended to improve procedural standardization and theoretically broaden periosteal lesion coverage while preserving procedural safety.
The aim of the present study was to describe a novel enhanced technique of radiofrequency ablation of the nerves innervating the knee joint using a “palisade” ruler and to present a clinical case.
Case Presentation
A 53-year-old Kazakh male of normal body habitus presented with a 6-month history of pain in the left knee joint. According to the Visual Analog Scale (VAS), the pain was described as sharp, rated at 5–6 points at rest and up to 8 points during walking. The pain was localized to the anteromedial and anterolateral regions of the knee without radiation. Both the nature and intensity of the pain significantly limited the patient’s daily activities and disrupted sleep. The patient had repeatedly undergone courses of conservative treatment, including nonsteroidal anti-inflammatory drugs, intra-articular injections, and physiotherapy; however, the therapeutic effect was transient, lasting approximately 2–3 weeks.
On physical examination, moderate swelling of the knee joint was observed, and palpation of the joint line elicited marked pain. The patient demonstrated a full range of motion in the knee joint. A validated functional questionnaire, such as WOMAC or KOOS, was not collected, which was considered a limitation of the clinical assessment further on. Crepitation was noted during knee flexion. Plain radiography of the left knee in two projections demonstrated Kellgren–Lawrence grade II osteoarthritis (1982) (Figure 3). Given the disease history and insufficient response to conservative therapy, the patient was recommended to undergo the described palisade-guided radiofrequency ablation technique targeting the articular branches of the knee joint using the “palisade” ruler.
Figure 3.
Plain radiographs of the left knee joint in Patient M. Left panel shows the anteroposterior radiographic view and right panel shows the lateral radiographic view. The findings are consistent with Kellgren–Lawrence grade II osteoarthritis. In figure: a represents the distance from the most prominent point of the corresponding femoral or tibial condyle to the planned skin entry point of the cannula, b is the length of the exposed active tip of the cannula, c is the actual cannula trajectory (hypotenuse), the straight-line path the cannula travels from the skin entry point to the target on the cortical surface.
Prior to the procedure, written informed consent was obtained from the patient for the performance of this invasive intervention as well as for participation in the study. Written informed consent was also obtained from the patient for publication of the case details and any accompanying images. Institutional approval was required for the study and publication of this case, and approval was obtained from the local ethics committee of the National Scientific Center of Traumatology and Orthopedics named after Academician N.D. Batpenov (Protocol No. 3/8, dated October 9, 2024).
As part of the preoperative preparation, insertion points for radiofrequency ablation cannulas were calculated on an anteroposterior radiograph of the knee joint. The calculations were performed using the formula:
 |
where a represents the distance from the most prominent point of the corresponding femoral or tibial condyle to the planned skin entry point of the cannula, b is the length of the exposed active tip of the cannula (a constant value of 1.0 cm-active tip length of the electrode used), and (α°) is the angle between the cortical surface of the condyle and a vertical line drawn through the most prominent point of the femoral and tibial condyles (Figure 4). The angle (α°) was measured directly on the radiograph using a protractor, after which the value of the cathetus a was calculated using a tangent table. In this manner, three groups of insertion points were determined: in the projection of the medial femoral condyle, the lateral femoral condyle, and the medial tibial condyle. This calculation was used as a simplified two-dimensional planning aid and not as a definitive anatomical model of the three-dimensional condylar surface. For example, at a cortical inclination angle (α°) of 55° for the medial femoral condyle, tan 55° equals 1.43, which, with b = 1.0 cm, yielded a distance of 1.43 cm from the most prominent point of the condyle.
 |
Figure 4.
Schematic illustration of radiofrequency ablation target localization. The label a denotes the calculated distance from the most prominent point of the corresponding femoral or tibial condyle to the planned cannula skin-entry point. The label b denotes the exposed active tip length of the radiofrequency cannula (1.0 cm in this case). The label c denotes the oblique cortical reference segment representing the bone surface of the condyle. The label alpha denotes the cortical inclination angle measured between the condylar cortical surface and the vertical reference line drawn through the most prominent point of the condyle. The vertical line represents the reference axis; the horizontal/distance marker represents the calculated offset for the entry point; point 1 denotes the most prominent condylar point; and point 2 denotes the corresponding planned cannula insertion point. The calculated distance was determined using the formula a = b × tan alpha.
At a cortical inclination angle (α°) of 50° for the lateral femoral condyle, the calculated value of a was 1.2 cm.
 |
For the medial surface of the tibia, with an angle (α°) of 38° and tan 38° = 0.78, the distance from the most prominent point of the condyle to the insertion site was 0.78 cm.
 |
Technique Description
After obtaining the patient’s informed consent for the procedure and for publication of the clinical case with accompanying photographs, the patient was positioned supine on the operating table, with the affected lower limb placed in slight flexion at the knee joint. Following placement of the image intensifier over the knee in the anteroposterior projection, primary marking of anatomical landmarks was performed. Under fluoroscopic guidance, the most prominent points of the medial and lateral femoral condyles, as well as the medial tibial condyle, were identified. The projections of these landmarks were transferred onto the skin using a metallic guide wire and marked with a surgical marker as a continuous line (Line 1), which served as the reference baseline for subsequent measurements (Figure 5).
Figure 5.
Marking of anatomical reference points under fluoroscopic guidance. The continuous red line, labeled Line 1, indicates the reference baseline corresponding to the fluoroscopic projection of the most prominent condylar points. Indicator 1 denotes the most prominent condylar reference point identified under fluoroscopy. Indicator 2 denotes the corresponding skin-surface mark transferred from the fluoroscopic image and used for subsequent cannula entry-site planning.
Next, the pre-calculated cannula insertion sites were marked on the skin. The calculated value of the cathetus a, representing the optimal distance for performing radiofrequency ablation, was measured on the skin using a ruler from Line 1 along the medial and lateral surfaces of the femur and the medial surface of the tibia. These insertion points were marked with a surgical marker as a dashed line (Line 2). The accuracy of the markings was verified by repeat fluoroscopic control (Figure 6). After completion of the skin marking, the operative field was prepared with a povidone–iodine–based antiseptic solution and draped with sterile surgical linens. Local infiltration anesthesia was then administered at the planned insertion sites using a 0.5% novocaine solution.
Figure 6.
Marking of cannula insertion sites under fluoroscopic guidance. (A) Shows cannula placement along the medial surface of the femur at the projection of the medial epicondyle. Fluoroscopic (C-arm) verification of cannula positioning was performed in the anteroposterior view, followed by fluoroscopic confirmation in the lateral view. (B) Shows cannula placement along the lateral surface of the femur at the projection of the lateral epicondyle. Fluoroscopic (C-arm) verification of cannula positioning was performed in the anteroposterior view, followed by fluoroscopic confirmation in the lateral view. (C) Shows cannula placement along the medial surface of the tibia at the projection of the medial condyle. Fluoroscopic (C-arm) verification of cannula positioning was performed in the anteroposterior view, followed by fluoroscopic confirmation in the lateral view. Line 1 - reference baseline drawn on the skin over anatomical landmarks (transferred via guide wire). Line 2 - dashed line marking the cannula insertion sites, measured from Line 1 at the calculated distance (cathetus a) along the femoral and tibial surfaces.
The radiofrequency ablation procedure was then performed according to the developed technique. Using the “palisade” ruler, three Cosman radiofrequency cannulas (100 mm in length) were sequentially inserted along the medial surface of the distal femur, strictly perpendicular to the longitudinal axis of the femur, in the supracondylar region (Figure 7A). After removal of the stylets, CSK-TC10 electrodes were introduced into the cannulas, and sensory stimulation was performed up to 0.5 V, during which the patient reported localized pressure without radiation, followed by motor stimulation up to 1.2 V, which elicited localized contraction of the periarticular musculature without involvement of the lower leg muscles. Subsequently, 1 mL of a 0.5% novocaine solution was injected through each cannula, and radiofrequency ablation was performed at a temperature of 80 °C for 90 seconds. In a similar manner, three cannulas were placed along the lateral surface of the distal femur, strictly at the previously calculated and marked points, perpendicular to the longitudinal axis of the femur (Figure 7B). After standard sensory and motor stimulation and novocaine infiltration, thermocoagulation was carried out using the same parameters (80°C for 90 seconds). The final stage involved radiofrequency ablation along the medial surface of the proximal tibia (Figure 7C). Three Cosman cannulas were inserted precisely at the points calculated using the formula, targeting the subcondylar region where the articular branches course at a minimal distance from the bone. Following sensory and motor testing and local anesthesia with novocaine, thermal lesioning was performed at a temperature of 80°C for 90 seconds. Upon completion of the procedure, the cannulas were removed, and the puncture sites were covered with sterile dressings.
Figure 7.
Cannula placement during radiofrequency ablation of the knee joint. (A) Shows cannula placement in the projection of the medial femoral condyle; (B) Shows cannula placement in the projection of the lateral femoral condyle; and (C) Shows cannula placement in the projection of the medial tibial condyle. In each panel, the three parallel cannulas indicate the palisade configuration used to create an elongated ablation zone along the periosteal surface. Red lines, arrows, or point markers indicate the planned cannula trajectory or insertion line, and numbered indicators identify the sequential cannula positions within the palisade arrangement.
No intraoperative or postoperative complications, adverse events, or signs of vascular or neural injury were observed upon completion of the procedure. In the early postoperative period, the patient experienced moderate localized discomfort at the puncture sites, described as dull and non-radiating, with pain intensity rated at 4–5 points on the Visual Analog Scale (VAS). The pain resolved spontaneously and decreased within the first 24 hours. The maximal clinical effect was observed on the second day following radiofrequency ablation, when the patient reported complete pain relief, with a VAS score of 0 both at rest and during daily activities. The patient was discharged in satisfactory condition on the fourth postoperative day. At follow-up examinations, the patient reported a pain intensity of 2 points on the Visual Analog Scale (VAS) at 3 months, 3 points at 6 months, and likewise 3 points at 9 months, which corresponded to a sustained clinical regression of symptoms. Functional recovery was assessed descriptively, the patient reported return to daily activities without limitations, but no validated functional outcome instrument was administered.
Discussion
The clinical course observed in this case suggests a favorable individual response to the proposed radiofrequency ablation (RFA) technique in a patient with knee osteoarthritis, which is consistent with current evidence from the literature. Despite the widespread use of the classical “three-point” technique targeting the superomedial (SMGN), superolateral (SLGN), and inferomedial (IMGN) genicular nerves, several randomized controlled trials and meta-analyses indicate that standard RFA provides pain relief only in a subset of patients and is often characterized by a temporary effect. For example, the meta-analysis by Li et al, which included eight randomized controlled trials and 625 patients, demonstrated a statistically significant reduction in pain and improvement in WOMAC scores up to 24 weeks; however, up to 35–40% of patients exhibited an incomplete clinical response.18 An updated meta-analysis (13 RCTs, 865 patients, publications up to 2023) confirmed significant pain reduction at all evaluated time points (1–2, 4, 12, and 24 weeks), improvement in WOMAC scores, and high patient satisfaction, while emphasizing substantial methodological heterogeneity and the lack of unified treatment protocols.19
These findings are consistent with the results of a large survey conducted by the American Society of Pain and Neuroscience (ASPN), which included 378 specialists and revealed marked variability in clinical RFA practice, ranging from differences in the use of diagnostic blocks and anesthetic agents to the selection of needles, temperature settings, and navigation criteria.14 Despite general agreement regarding the three primary target nerves, a temperature of 80°C, and an ablation duration of 90 seconds, no standardized protocol currently exists, which limits comparability of clinical outcomes.
One of the key reasons for the limited efficacy of the traditional technique is the simplified understanding of knee joint innervation. The classical anatomical model reviewed by Roberts et al20 served as the foundation for clinical protocols for decades; however, contemporary morphological studies have substantially revised this concept The study by Tran et al demonstrated that the anterior capsule of the knee joint is innervated by at least ten nerve branches, including the nerve to the vastus medialis, the nerve to the vastus intermedius, the branch to the vastus lateralis, the recurrent branch of the common fibular nerve, the infrapatellar branch of the saphenous nerve, and other structures. Additional evidence regarding the variability and density of these branches has been provided by three-dimensional anatomical reconstructions.11 Importantly, most of these branches are located in close proximity to the periosteum—less than 1 mm from the bone surface—predominantly in the region of the most prominent areas of the femoral and tibial condyles. This anatomical arrangement explains why focal monopolar ablation of only three genicular nerves may result in incomplete denervation. Even with precise targeting, a high likelihood of preservation of sensory branches remains, as confirmed by both morphological studies and clinical observations.12
The RFA technique developed by our group aims to overcome these limitations. The use of the “palisade” ruler, previously applied in the treatment of sacroiliac joint pain,16 allows a parallel multi-cannula configuration intended to produce a more continuous periosteal lesion pattern along the osseous surface. In addition, the multifocal arrangement of cannulas may theoretically increase coverage not only of the main genicular nerves but also of additional periosteal branches described by Tran et al However, the present case does not provide direct anatomical or imaging confirmation that these branches were completely denervated, which is another limitation of the study.
One procedural feature of the technique is the mathematical modeling of preoperative insertion points using the formula a = b × tan α°. This calculation is intended to assist in estimating cannula entry points according to visible radiographic cortical inclination, but it should not be interpreted as a precise anatomical model. The distal femur and proximal tibia have complex three-dimensional morphology, and a two-dimensional anteroposterior radiograph cannot fully account for cortical curvature, individual anatomical variation, or radiographic projection effects. In addition, direct measurement of α on a standard radiograph using a protractor may introduce inter- and intra-observer variability, particularly depending on X-ray beam positioning. Therefore, future studies should evaluate the reliability of this measurement method and consider digital planning tools or advanced imaging guidance.
The presented clinical case does not prove superiority of the technique, but it illustrates a potentially useful structured planning strategy As early as the second postoperative day, the patient reported complete pain relief (VAS score of 0), exceeding the typical onset of effect reported in most studies of standard RFA, where maximal pain reduction is usually observed within 1–3 weeks. However, this outcome must be interpreted cautiously because it represents a single patient, and the clinical assessment was based primarily on VAS scores and descriptive functional recovery. No WOMAC, KOOS, or other validated functional questionnaire was collected, limiting interpretation of functional benefit. The absence of adverse events is consistent with the findings of Kim et al, who reported a low incidence of serious complications associated with periosteally oriented RFA.10 Sustained pain regression (VAS 0–2) was observed throughout the 9-month follow-up period, indicating a durable clinical effect.
Given its anatomical rationale, expanded ablation zone, and preliminary clinical outcomes, the proposed technique may be considered a hypothesis-generating modification. However, despite the positive clinical case and excellent individual outcomes, further studies are required to definitively confirm the effectiveness of this technique, including prospective case series, comparative studies with conventional and cooled radiofrequency ablation, and large-scale randomized clinical trials.
This report has several important limitations. First, it describes the outcome of a single patient; therefore, the findings should be considered preliminary and hypothesis-generating rather than evidence of reproducible clinical efficacy. Second, clinical follow-up was based mainly on VAS pain scores and descriptive functional recovery, without validated functional outcome instruments such as WOMAC or KOOS. Third, the proposed geometric calculation is a simplified two-dimensional planning aid based on anteroposterior radiography and cannot fully account for the complex three-dimensional morphology of the distal femur and proximal tibia, radiographic projection variability, or inter- and intra-observer measurement error. Fourth, no post-procedural MRI or other advanced imaging was performed to confirm the actual dimensions of the thermal lesion, complete denervation of target branches, or absence of osseous, cartilaginous, or soft-tissue collateral effects. Fifth, exact BMI and objective subcutaneous tissue thickness were not available, although these variables may influence fluoroscopically guided percutaneous cannula placement. Finally, anatomical and cadaveric studies are required to determine whether the proposed palisade-guided configuration reliably covers the intended periosteal nerve branches.
Conclusion
The presented clinical case suggests that a structured, geometrically guided palisade modification of genicular radiofrequency ablation may be feasible and may provide sustained pain reduction in an individual patient with knee osteoarthritis. The method is based on contemporary concepts of the multibranch innervation of the anterior knee capsule and uses individualized preprocedural planning to guide multi-cannula periosteal placement.
However, because this is a single case report, the findings should be interpreted cautiously. The actual dimensions of the ablation zone, the degree of denervation of target sensory branches, and the absence of collateral osseous or cartilaginous effects were not confirmed by post-procedural imaging. In addition, functional improvement was not assessed using a validated questionnaire. Further anatomical, cadaveric, imaging-based, prospective, and comparative clinical studies are required to determine the reproducibility, safety, and clinical effectiveness of this technique.
Acknowledgments
Thanks to the National Scientific center of traumatology and orthopedics named after N.D. Batpenov for this opportunity.
Funding Statement
This study had no funding.
Data Sharing Statement
The data supporting the findings of this case report are available from the corresponding author upon reasonable request.
Ethics Approval and Consent to Participate
The study was conducted in accordance with the Declaration of Helsinki and approved by local ethics committee of the National Scientific Center of Traumatology and Orthopedics named after Academician N.D. Batpenov (Protocol No. 3/8, dated October 9, 2024). Informed consent for participation in study was obtained from patient.
Consent for Publication
Written informed consent was obtained from the patient for publication of the case details and any accompanying images.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflict of interest in this work.
References
- 1.Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745–11. PMID:31034380. doi: 10.1016/S0140-6736(19)30417-9 [DOI] [PubMed] [Google Scholar]
- 2.Konya ZY, Akin Takmaz S, Başar H, Baltaci B, Babaoğlu G. Results of genicular nerve ablation by radiofrequency in osteoarthritis-related chronic refractory knee pain. Turk J Med Sci. 2020;50(1):86–95. doi: 10.3906/sag-1906-91 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: part I. Casp J Intern Med. 2011;2:205–212. [PMC free article] [PubMed] [Google Scholar]
- 4.Safiri S, Kolahi AA, Smith E, et al. Global, regional and national burden of osteoarthritis 1990–2017: a systematic analysis of the Global Burden of Disease Study 2017. Ann Rheum Dis. 2020;79(6):819–828. doi: 10.1136/annrheumdis-2019-216515 [DOI] [PubMed] [Google Scholar]
- 5.Dai WL, Lin ZM, Guo DH, et al. Efficacy and safety of hylan versus hyaluronic acid in the treatment of knee osteoarthritis. J Knee Surg. 2019;32:259–268. doi: 10.1055/s-0038-1641142 [DOI] [PubMed] [Google Scholar]
- 6.Li W, Pan Y, Yang Q, et al. Extracorporeal shockwave therapy for the treatment of knee osteoarthritis: a retrospective study. Medicine. 2018;97(31):e11418. doi: 10.1097/MD.0000000000011418 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Saseen JJ. Which is most effective for osteoarthritis of the knee: rofecoxib, celecoxib, or Acetaminophen? J Fam Pract. 2002;51(4):307. [PubMed] [Google Scholar]
- 8.Southworth TM, Naveen NB, Tauro TM, et al. The use of platelet-rich plasma in symptomatic knee osteoarthritis. J Knee Surg. 2019;32(1):37–45. doi: 10.1055/s-0038-1675170 [DOI] [PubMed] [Google Scholar]
- 9.Sperry BP, Conger A, Kohan L, Walega DR, Cohen SP, McCormick ZL. A proposed protocol for safe radiofrequency ablation of the recurrent fibular nerve for the treatment of chronic anterior inferolateral knee pain. Pain Med. 2021;22(5):1237–1241. doi: 10.1093/pm/pnaa291 [DOI] [PubMed] [Google Scholar]
- 10.Kim SY, Le PU, Kosharskyy B, Kaye AD, Shaparin N, Downie SA. Is genicular nerve radiofrequency ablation safe? A literature review and anatomical study. Pain Physician. 2016;19(5):E697–E705. PMID:27389113. [PubMed] [Google Scholar]
- 11.Tran J, Peng PWH, Lam K, et al. Anatomical study of the innervation of the anterior knee joint capsule: implication for image-guided intervention. Reg Anesth Pain Med. 2018;43(4):407–414. doi: 10.1097/AAP.0000000000000778 [DOI] [PubMed] [Google Scholar]
- 12.Balcazar de León S, Cintron L, Beas Magdaleno GA, Delangel Solís Cámara BB. Modified bipolar radiofrequency ablation in the denervation of the anterior capsule of the knee guided by ultrasound for the management of osteoarthritis: case report and technique description. Med Pain J. 2025;5:83–90. doi: 10.20986/mpj.2025.1095 [DOI] [Google Scholar]
- 13.Nnake CO, El-Othmani MM, Cooper HJ, Shah RP, Geller JA, Neuwirth AL. Genicular nerve radiofrequency ablation: a systematic review of application for perioperative pain control in total knee arthroplasty and as treatment for chronic pain in well-appearing total knee arthroplasty. Knee Surg Relat Res. 2024;36(1):18. PMID:38764084; PMCID:PMC11103950. doi: 10.1186/s43019-024-00222-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Abd-Elsayed A, Strand N, Gritsenko K, et al. Radiofrequency ablation for the knee joint: a survey by the American Society of Pain and Neuroscience. J Pain Res. 2022;15:1247–1255. PMID:35509622; PMCID:PMC9057892. doi: 10.2147/JPR.S342653 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Kuleshov AA, Darchiya LY. Radiofrequency Denervation in the Treatment of Vertebrogenic Pain Syndrome [Monograph]. Author’s edition; 2019:150–151. [Google Scholar]
- 16.Rejaei D, Singh N, Sheth S, Koebner I, Fishman SM. A novel approach to the treatment of sacroiliac joint complex pain: bipolar radiofrequency ablation applied in a palisade pattern. Reg Anesth Pain Med. 2016;41(3):416–417. doi: 10.1097/AAP.0000000000000385 [DOI] [PubMed] [Google Scholar]
- 17.Anashev TS, Shaukhin YN. Method of radiofrequency ablation for knee osteoarthritis. Author’s Certificate No. 55600. Republic of Kazakhstan; 2025. [Google Scholar]
- 18.Li G, Zhang Y, Tian L, Pan J. Radiofrequency ablation reduces pain for knee osteoarthritis: a meta-analysis of randomized controlled trials. Int J Surg. 2021;91:105951. doi: 10.1016/j.ijsu.2021.105951 [DOI] [PubMed] [Google Scholar]
- 19.Zeng C, Li H, Yang T, et al. Efficacy and safety of radiofrequency treatment for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res. 2023;18(1):51. doi: 10.1186/s13018-023-03407-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Roberts SL, Stout A, Dreyfuss P. Review of knee joint innervation: implications for diagnostic blocks and radiofrequency ablation. Pain Med. 2020;21(5):922–938. PMID: 31407791. doi: 10.1093/pm/pnz189 [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data supporting the findings of this case report are available from the corresponding author upon reasonable request.