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Genicular Nerve Radiofrequency Ablation Before and After Magnetic Resonance Imaging Anatomical Mapping: Case Study
Terence Hillery1, Suzanna Shermon1, David Di Lorenzo1
1Case Western Reserve University/MetroHealth, Pain Division, Department of Physical Medicine and Rehabilitation, Cleveland, OH.
Background:
Chronic knee pain is a significant cause of morbidity for which radiofrequency ablation (RFA) of genicular nerves (GN) may be considered. However, treatment effectiveness depends on accurate placement of RFA probes, and there remains uncertainty on GN anatomical location.
Case Report:
A 21-year-old man presented with 2 months of severe knee pain following a canoe trip. Hoffa's fat impingement was diagnosed with magnetic resonance imaging (MRI), and a subsequent fat pad injection was unsuccessful. After GN blocks, RFA provided 90% relief for 4 weeks. At this time, RFA was performed with probe placement determined by the patient's MRI-mapped GN neurovascular bundle location. At 8 weeks, the patient continues to have 100% left knee pain relief.
Conclusion:
This case suggests that MRI-mapped GNs may assist in planning genicular RFA to improve probe and nerve apposition.
