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Kolakkanni C, Gonnade NM, Gaur R, Nayyar AK, Ghuleliya R, Tk A. Can ultrasound-guided radiofrequency ablation of genicular nerves of the knee, be performed without locating corresponding arterial pulsations-a cadaveric study. BMC Musculoskelet Disord 2023; 24:654. [PMID: 37587439 PMCID: PMC10429091 DOI: 10.1186/s12891-023-06761-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Given the rising prevalence of knee osteoarthritis, radiofrequency ablation of genicular nerves (RFA) has emerged as a promising treatment option for knee pain. The knee has an extremely complex and variable innervation with nearly 13 genicular nerves described. The frequently ablated genicular nerves are the superomedial (SMGN), the superolateral (SLGN), and the inferomedial (IMGN) genicular nerves. Conventionally, under ultrasound guidance, these nerves are ablated near the corresponding arterial pulsations, but due to the rich vascular anastomosis around the knee joint, identifying the arteries corresponding to these constant genicular nerves can be tedious unless guided by some bony landmarks. In this study, we have evaluated whether it is possible to accurately target these three genicular nerves by just locating bony landmarks under ultrasound in human cadaveric knee specimens. METHODS Fifteen formalin-fixed cadaveric knee specimens were studied. SMGN was targeted 1 cm anterior to the adductor tubercle in the axial view. For SLGN, in the coronal view, the junction of the lateral femoral condyle and shaft was identified, and at the same level in the axial view, the crest between the lateral and posterior femoral cortex was targeted. For IMGN in the coronal view, the midpoint between the most prominent part of the medial tibial condyle and the insertion of the deep fibers of the medial collateral ligament was marked. The medial end of the medial tibial cortex was then targeted at the same level in the axial view. The needle was inserted from anterior to posterior, with an in-plane approach for all nerves. Eosin, 2% W/V, in 0.1 ml was injected. Microdissection was done while keeping the needle in situ. Staining of the nerve was considered a positive outcome, and the percentage was calculated. The nerve-to-needle distance was measured, and the mean with an interquartile range was calculated. RESULT The accuracies of ultrasound-guided bony landmarks of SMGN, SLGN, and IMGN were 100% in terms of staining, with average nerve-to-needle distances of 1.67, 3.2, and 1.8 mm respectively. CONCLUSION It is with 100% accuracy, that we can perform RFA of SMGN, SLGN, and IMGN under ultrasound guidance, by locating the aforementioned bony landmarks.
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Affiliation(s)
- Chinchu Kolakkanni
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Phase 2 Basni, Jodhpur, Rajasthan, India, 342005
| | - Nitesh Manohar Gonnade
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Phase 2 Basni, Jodhpur, Rajasthan, India, 342005.
| | - Ravi Gaur
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Phase 2 Basni, Jodhpur, Rajasthan, India, 342005
| | - Ashish Kumar Nayyar
- Department of Anatomy, All India Institute of Medical Sciences, Phase 2 Basni, Jodhpur, Rajasthan, India
| | - Rambeer Ghuleliya
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Phase 2 Basni, Jodhpur, Rajasthan, India, 342005
- Department of Physical Medicine and Rehabilitation, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Doiwala, Jolly Grant, Dehradun, Uttarakhand, India, 248140
| | - Abins Tk
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Phase 2 Basni, Jodhpur, Rajasthan, India, 342005
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Ma J, Zhao W, Pei X, Li X, Zhao W. MicroRNA-345-3p is a potential biomarker and ameliorates rheumatoid arthritis by reducing the release of proinflammatory cytokines. J Orthop Surg Res 2023; 18:399. [PMID: 37264454 DOI: 10.1186/s13018-023-03797-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/13/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES The study was to explore the influence of microRNA (miR)-345-3p on proinflammatory cytokines in patients with rheumatoid arthritis (RA). METHODS A total of 32 RA patients and 32 healthy patients were enrolled. Proinflammatory factors in patients' serum were detected by ELISA, and miR-345-3p was detected by RT-qPCR. The correlation between miR-345-3p expression and proinflammatory factors in RA patients was analyzed. The diagnostic value of miR-345-3p and proinflammatory factors in RA patients was analyzed by receiver operating curve diagnosis. The predictive value of miR-345-3p levels and proinflammatory factors in RA patients was analyzed by multivariate Cox regression. HFLS-RA and HFLS cells were cultured, in which miR-345-3p and proinflammatory cytokines were detected by RT-qPCR. Cell proliferation and apoptosis were determined by CCK-8 and flow cytometry, respectively. RESULTS MiR-345-3p was lowly expressed in the serum of RA patients. MiR-345-3p and proinflammatory factors were of diagnostic and predictive values in RA. Elevated miR-345-3p restrained the production of proinflammatory factors of HFLS-RA cells, improved cell proliferation, and reduced apoptosis. CONCLUSION MiR-345-3p is a potential biomarker and ameliorates RA by reducing the release of proinflammatory cytokines.
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Affiliation(s)
- Jun Ma
- Department of Orthopedics, Jiu Quan People's Hospital, No. 22, West Street, Suzhou District, Jiu Quan City, 735000, Gansu Province, China
| | - Wei Zhao
- Department of Orthopedics, Jiu Quan People's Hospital, No. 22, West Street, Suzhou District, Jiu Quan City, 735000, Gansu Province, China
| | - Xue Pei
- Department of Orthopedics, Jiu Quan People's Hospital, No. 22, West Street, Suzhou District, Jiu Quan City, 735000, Gansu Province, China
| | - XinZhi Li
- Department of Orthopaedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang City, 443001, Hubei Province, China
| | - Wei Zhao
- Department of Orthopedics, Jiu Quan People's Hospital, No. 22, West Street, Suzhou District, Jiu Quan City, 735000, Gansu Province, China.
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Genicular nerve block in juvenile idiopathic arthritis: a randomized clinical trial. Clin Rheumatol 2023; 42:879-888. [PMID: 36197647 PMCID: PMC9935707 DOI: 10.1007/s10067-022-06389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study aimed at evaluating the effect of genicular nerve block (GNB) in juvenile idiopathic arthritis (JIA) patients with persistent unilateral knee arthritis on pain, inflammatory parameters, function, and range of motion. METHODS A total of 104 JIA patients were diagnosed according to the International League Against Rheumatism (ILAR) criteria with persistent unilateral knee arthritis. They were allocated randomly into 2 groups: group 1 treated with GNB, while group 2 was treated with intra-articular triamcinolone (TA) only. Visual analogue scale (VAS) on pain, sonography of large joints in rheumatology (SOLAR) scoring system, and Lysholm scores were assessed at 0-, 2-, and 12-week intervals. Swelling and tenderness were clinically evaluated semi-quantitatively (0-3) at the same time intervals. RESULTS VAS pain, tenderness, swelling, and SOLAR grey scale (GS) and power Doppler (PD) scores were significantly reduced after 2 weeks in both groups (p < 0.05). This was greater in the GNB group regarding VAS and tenderness, while SOLAR and swelling were stronger reduced in TA group. After 12 weeks, all outcome measures showed lower values in the GNB group compared to TA, and this was significant regarding VAS pain. Moreover, Lysholm functional score was significantly increased in both groups at both intervals; and higher values were seen in the TA group compared to GNB after 2 weeks. CONCLUSION GNB was able to control pain and improve function and inflammation of the knee joint in JIA patients. Though steroid attained better results after 2 weeks, GNB achieved an equivalent longer-term improvement after 12 weeks. TRIAL REGISTRATION IDENTIFYING NUMBER NCT04687930. Key Points • Persistent knee arthritis treatment in JIA is always challenging. • GNB was approved for treatment of pain in knee osteoarthritis. • GNB in the present study succeeded to control active knee arthritis and this effect was comparable to intra-articular steroid injection.
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Malaithong W, Tontisirin N, Seangrung R, Wongsak S, Cohen SP. Bipolar radiofrequency ablation of the superomedial (SM), superolateral (SL) and inferomedial (IM) genicular nerves for chronic osteoarthritis knee pain: a randomized double-blind placebo-controlled trial with 12-month follow-up. Reg Anesth Pain Med 2022; 48:rapm-2022-103976. [PMID: 36543391 PMCID: PMC9985752 DOI: 10.1136/rapm-2022-103976] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Variability in anatomy in the knees supports the use of aggressive lesioning techniques such as bipolar-radiofrequency ablation (RFA) to treat knee osteoarthritis (KOA). There are no randomized controlled trials evaluating the efficacy of bipolar-RFA. METHODS Sixty-four patients with KOA who experienced >50% pain relief from prognostic superomedial, superolateral and inferomedial genicular nerve blocks were randomly assigned to receive either genicular nerve local anesthetic and steroid injections with sham-RFA or local anesthetic and steroid plus bipolar-RFA. Participants and outcome adjudicators were blinded to allocation. The primary outcome was Visual Analog Scale pain score 12 months postprocedure. Secondary outcome measures included Western Ontario and McMaster Universities Arthritis (WOMAC) and Patient Global Improvement-Indexes (PGI-I). RESULTS Both groups experienced significant reductions in pain, with no significant differences observed at 12 months (reduction from 5.7±1.9 to 3.2±2.6 in the RFA-group vs from 5.0±1.4 to 2.6±2.4 in the control-group (p=0.40)) or any other time point. No significant changes were observed between groups for WOMAC and PGI-I at the primary endpoint, with only the control group experiencing a significant improvement in function at 12-month follow-up (mean reduction from 91.2±38.2 to 67.1±51.9 in the RFA-group (p=0.06) vs from 95.8±41.1 to 60.6±42.8 in the control group (p=0.001); p=0.85 between groups). CONCLUSION Our failure to find efficacy for genicular nerve RFA, coupled with evidence showing that a plenitude of nerves supply the knee joint and preliminary studies indicating superiority of lesioning strategies targeting more than three nerves, suggest controlled trials using more aggressive lesioning strategies are warranted. TRIAL REGISTRATION NUMBER TCTR20170130003.
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Affiliation(s)
| | - Nuj Tontisirin
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rattaphol Seangrung
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Siwadol Wongsak
- Department of Orthopedic Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Steven P Cohen
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Departments of Anesthesiology and Critical Care Medicine, Neurology, Physical Medicine & Rehabilitation, and Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Departments of Anesthesiology and Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Zaragoza G, Solorzano-Flores SY, Pineda C, Soto-Fajardo C. Ultrasound-guided genicular nerve block a new treatment in rheumatology for knee osteoarthritis pain. Rheumatol Int 2022; 42:1663-1664. [PMID: 35713678 DOI: 10.1007/s00296-022-05162-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
Affiliation(s)
- G Zaragoza
- Anesthesiology Division, National Institute Rehabilitation Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - S-Y Solorzano-Flores
- Department of Ultrasound, Division of Rheumatology, National Institute Rehabilitation Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - C Pineda
- Department of Ultrasound, Division of Rheumatology, National Institute Rehabilitation Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - C Soto-Fajardo
- Department of Ultrasound, Division of Rheumatology, National Institute Rehabilitation Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.
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Güler T, Yurdakul FG, Önder ME, Erdoğan F, Yavuz K, Becenen E, Uçkun A, Bodur H. Ultrasound-guided genicular nerve block versus physical therapy for chronic knee osteoarthritis: a prospective randomised study. Rheumatol Int 2022; 42:591-600. [PMID: 35165769 PMCID: PMC8852952 DOI: 10.1007/s00296-022-05101-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/01/2022] [Indexed: 12/28/2022]
Abstract
To compare the effectiveness of ultrasound-guided genicular nerve block (GNB) and physical therapy (PT) in patients with chronic knee osteoarthritis. A prospective randomised study with 102 patients (45–70 years) was performed wherein the patients received ultrasound-guided GNB (n = 51) and PT (n = 51) along with a standard home exercise programme. Scores for pain on a Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 6-min walking test (6MWT) were assessed pre-treatment and at 2- and 12-weeks post-treatment. Both groups were comparable for sociodemographic characteristics. VAS scores (in mm) in the ultrasound-guided GNB group at 0, 2 and 12 weeks were 7.01 ± 1.36; 3.71 ± 2.18; 5.08 ± 2.22 (p < 0.001) and 6.64 ± 1.99; 4.35 ± 1.09; 5.25 ± 1.33, (p < 0.001) in the PT group. While the increase in the 6MWT test in the 2nd week was similar for both groups (p = 0.073), the increase in walking distance was greater in the ultrasound-guided GNB group at 12 weeks (p = 0.046). As compared to PT, ultrasound-guided GNB is beneficial in reducing pain and increasing functional and physical capacity, with greater retention of effects on the physical capacity seen at 12 weeks. Trial registration number: ClinicalTrials.gov (NCT04782401).
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Affiliation(s)
- Tuba Güler
- Physical Medicine and Rehabilitation Hospital, Ankara City Hospital, Ankara, Turkey
| | - Fatma Gül Yurdakul
- Physical Medicine and Rehabilitation Hospital, Ankara City Hospital, Ankara, Turkey
| | - Mustafa Erkut Önder
- Division of Rheumatology, Training and Research Hospital, Aksaray University, Aksaray, Turkey
| | - Faruk Erdoğan
- Physical Medicine and Rehabilitation Hospital, Ankara City Hospital, Ankara, Turkey
| | - Kaan Yavuz
- Physical Medicine and Rehabilitation Hospital, Ankara City Hospital, Ankara, Turkey
| | - Elif Becenen
- Physical Medicine and Rehabilitation Hospital, Ankara City Hospital, Ankara, Turkey
| | - Aslı Uçkun
- Department of Physical Medicine and Rehabilitation, İzmir Medicana Hospital, İzmir, Turkey
| | - Hatice Bodur
- Physical Medicine and Rehabilitation Hospital, Ankara City Hospital, Ankara, Turkey
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