Refining Knee Radiofrequency Ablation with a Palisade- Guided Technique: A Case Report

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.

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.

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.