ESRA Academy. But M. Sep 8, 2016; 138619; 0505 Topic: INTERVENTIONAL TECHNIQUES
Michal But
Michal But

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Background and Aims:

Chronic knee pain is a common  cause of  significant disability and affects quality of life (1).  One of the interventional methods for the treatment of chronic knee pain is thermal coagulation of genicular nerves (2)


Traditionally the procedure is performer under fluoroscopic guidance only. The techniques requires  maneuvering  the C-arm in both A-P and lateral projection .  Reliability of ultrasound guidance  in comparison with  fluoroscopy has been already described.(3)

In authors modification  double guidance is used and for the inferior medial genicular branch the needle is advanced under ultrasound guidance in plane view from lateral to medial, sliding on tibia tuberosity until the active tip reach the medial edge of the bone .


Using the ultrasound guidance there is no need to shift  the C-arm and  to obtain the lateral view. Moreover patient lies comfortable with both legs together and there is no need to move contralateral leg. The needle tip more tangential to the nerve allows  more efficient thermal coagulation.


Double guidance allows for faster and more efficient thermal coagulation of the genicular nerves.

  1. Hopman-Rock M. et al. Physical and psychosocial disability in elderly subjects in elderly subjects in relation to pain hip / or knee. J Rheumatol 1996;23:1037-44

  2. Woo-Jong Ch. et al. Radiofrequency treatment relives chronic knee pain: A double – blind randomized controlled trial . PAIN 152(2011)481-487

  3. Ghassemi Nejad B, Krol A, Tavakkolizadeh M.  Novel ultrasound guided genicular nerves blockade and radiofrequency denervation in comparison to fluoroscopy guided technique . Reg Anesth Pain Med,Vol 40, N5, suppl 5, e-146, 2015

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