Unveiling sex- and side-specific variations in genicular nerve targeting: implications for precision in nerve ablation therapy

BACKGROUND: Genicular nerve radiofrequency denervation, blocks, and neurolysis are effective techniques for pain from knee osteoarthritis (OA) by targeting specific sensory nerves. However, anatomical variability related to laterality and sex may influence targeting accuracy. This study systematically evaluated these factors to optimise procedural precision. METHODS: Twenty-seven frozen lower limbs (10 bilateral: 6 females and 4 males; 7 unilateral: 5 males and 2 females; mean age 84.5 ± 10.8 years) were dissected from the proximal thigh to the knee following colored latex injection. Nerve diameters and distances from genicular nerves to relevant bony landmarks were measured and compared by sex and side using standard statistical tests (p < 0.05). RESULTS: No significant differences were observed in the distances from the target points to the bony landmarks between either men and women or left and right sides. These were larger, on average, in males than in females, except for the distance from the superomedial genicular nerve (SMGN) to the medial condyle. The inferomedial genicular nerve (IMGN) measured diameter at the target point was statistically larger in females than in males [p = 0.04(CI; -0.39–0.05)]. Interestingly, 44.4% of the superolateral genicular nerve (SLGN) showed no proximity to vascular supply at the target point, which is necessary for ultrasound-assisted targeting. CONCLUSION: Although minor dimensional differences exist, sex- and laterality-based anatomical variations do not significantly influence genicular nerve targeting for pain interventions. These findings support the applicability of current targeting protocols across sexes and sides for effective knee OA pain management.