The Value of Preprocedural MR Imaging in Genicular Artery Embolization for Patients with Osteoarthritic Knee Pain

Minimally invasive interventional procedures for osteoarthritis and inflammatory arthritis: A systematic review and meta-analysis

OBJECTIVE

to summarize the evidence on the efficacy of minimally invasive interventional procedures such as radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) in patients with osteoarthritis or inflammatory arthritis.

METHODS

a literature search was conducted in PubMed and Web of Science databases. Both randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSI) were included. The results were organized according to the treated anatomical site: knee, hip, foot and ankle, shoulder, hand and wrist, sacroiliac joints. Data about treatment efficacy were extracted. The main outcome was change in pain intensity using the 0-10 visual analog scale (VAS) from baseline to 1 month. Additional timepoints at 3, 6 and 12 months were assessed. Change in functional status was evaluated. Pooled estimates were calculated as the mean difference (MD) and 95 % confidence interval relative to baseline. The meta-analyses of RCTs and NRSI were conducted separately.

RESULTS

of the 4599 retrieved articles, 164 were included in the review and, considering all the established timepoints, 111 (38 RCTs and 73 NRSI) were selected for the meta-analysis. Only one article described patients with inflammatory arthritis. In the meta-analysis of RCTs, one month after the procedure, MD in VAS was -3.98 (-4.41 to -3.55; k = 21) for knee RFA, and -3.18 (-3.96 to -2.39; k = 8) for sacroiliac joints RFA. In the meta-analysis of NRSI, MD in VAS was -4.12 (-4.63 to -3.61; k = 23) for knee RFA, -3.84 (-4.77 to -2.92; k = 7) for knee TAE, -4.34 (-4.96 to -3.71; k = 2) for hip RFA, -3.83 (-4.52 to -3.15; k = 3) for shoulder RFA and -4.93 (-5.58 to -4.28; k = 14) for sacroiliac joints RFA. Significant decrease in pain intensity was found also at 3, 6 and 12 months. Additionally, functional status improved at all the assessed timepoints.

CONCLUSION

minimally invasive interventional procedures can improve pain and functional status of patients affected by OA or chronic sacroiliac pain of degenerative origin. Further research is warranted in the field of inflammatory rheumatic diseases.

Effectiveness of Genicular Artery Embolization for Reducing Synovitis as Assessed by Contrast-Enhanced MR Imaging in Knee Osteoarthritis: A Pilot Study

PURPOSE

To investigate the impact of genicular artery embolization (GAE) on synovitis in knee osteoarthritis (OA) using contrast-enhanced magnetic resonance (MR) imaging and to assess its predictive role in pain response.

MATERIALS AND METHODS

A single-center retrospective analysis was conducted using contrast-enhanced MR imaging on 33 patients treated with GAE for knee OA between December 2022 and March 2023. MR assessments before the procedure and at 3 months after embolization were utilized in a semiquantitative scoring system for synovitis severity and distribution analysis. Pain and function through Western Ontario and McMaster Universities Osteoarthritis Index and visual analog scale scores were also assessed.

RESULTS

Significant synovitis reduction was noted after GAE, particularly in parapatellar and periligamentous areas. Synovial contrast enhancement scores significantly decreased from 5.1 (SD ± 2.0) to 2.9 (SD ± 2.0) at 3 months (P < .001), with a moderate negative correlation between synovial enhancement scores and pain levels (P = .005).

CONCLUSIONS

GAE significantly reduced synovitis in knee OA, evidenced by contrast-enhanced MR imaging. The correlation between preprocedural synovial contrast enhancement scores and pain relief after the procedure, although promising, requires careful interpretation because of the complex factors affecting pain in knee OA.

Angioembolization in the management of joint pain: current concepts

Joint pain is a common complaint owing to its origin in inflammatory and degenerative joint diseases. Recent research has helped narrow down inadequate angiogenesis as one of the causes. Angioembolization has emerged as a treatment option for this condition when it is refractory to conservative treatment. This review describes angioembolization by elaborating on the mechanism, safety, efficacy, comparative analysis of treatment and the road ahead, in addition to summarizing the existing data on this treatment. The inferences from this review further consolidate transcatheter arterial embolization as one of the prime options for managing joint pain when it is refractory to conservative treatment and label it as one of the most exciting prospects. A limitation of this review is that most of the data were from open label case series or case reports.

Geniculate Artery Embolization for the Treatment of Mild to Moderate Knee Osteoarthritis Improves Pain and Function at Short-Term Follow-Up With Significant Procedural Heterogeneity Described Across the Literature: A Systematic Review

PURPOSE

To evaluate procedural heterogeneity, patient-reported outcomes (PROs), and complications following geniculate artery embolization (GAE) for knee osteoarthritis (OA).

METHODS

A literature search was performed using PubMed, Embase, and Scopus databases from inception to August 2023 according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Human clinical studies reporting PROs following GAE for treatment of knee OA were included, and a qualitative comparison across PROs, procedural descriptions, and complications was performed. Study quality was assessed using the Cochrane Collaboration's risk of bias tool and the Methodological Index for Non-Randomized Studies criteria. The primary outcome measures included changes in PROs at 12 months and variances in procedural methodology.

RESULTS

A total of 17 studies, consisting of 533 patients and 620 knees, were identified. The reported mean improvement at 12 months for visual analog scale for pain and Western Ontario and McMaster Universities Arthritis Index scores ranged from 10 to 59 and 35.3 to 47, respectively. At 12 months, median improvements were observed in Knee injury and Osteoarthritis Outcome Score subscales such as Pain (range, 8.3-19.5), Quality of Life (15.49-25.0), Sport (7.5-26.3), and Symptoms (1.8-25.0). Decreasing minimal clinically important difference (MCID) achievement was observed between the 3-month and 6-month follow-up points. Patients with advanced OA and degenerative findings on magnetic resonance imaging exhibited lower rates of MCID achievement. Transient adverse events occurred in up to 80% of patients. Limited evidence from serial magnetic resonance imaging assessments suggests that GAE improves levels of synovitis. Significant heterogeneity exists among the GAE methodology as 4 different definitions of technical success, 4 distinct embolization targets, and use of 5 embolization agents were noted.

CONCLUSIONS

GAE results in short-term improvements in pain and function with decreasing MCID achievement observed after 3 to 6 months. Patients with severe OA also demonstrate lower rates of MCID achievement. A high rate of transient complications is reported, including skin discoloration and access site hematomas. Significant protocol heterogeneity exists, which contributes to variable outcomes.

LEVEL OF EVIDENCE

Level IV, systematic review of Level IV studies.

Society of Interventional Radiology Research Reporting Standards for Genicular Artery Embolization

Genicular artery embolization (GAE) is an emerging, minimally invasive therapy to address the global burden of knee osteoarthritis (OA) and the unmet needs for medically refractory disease. Although total knee arthroplasty has been a standard intervention for severe cases, GAE is developing into a promising alternative, particularly for patients ineligible for or unwilling to undergo surgery. GAE targets the inflammatory cascade underlying OA pathophysiology by arresting neoangiogenesis and preventing pathological neoinnervation, offering potential pain relief. Although early studies have established safety and short-term effectiveness, ensuing studies are needed to validate long-term safety, durability, and comparative effectiveness and to optimize patient selection, embolic agent selection, and administration techniques. Standardized reporting guidelines are therefore essential to enhance transparency and reproducibility across clinical trials, facilitating data aggregation and comparison. This Society of Interventional Radiology (SIR)-endorsed reporting standards consensus document provides a framework to harmonize future research efforts and to improve the interpretation of outcomes.

Genicular Artery Embolization: A New Tool for the Management of Refractory Osteoarthritis-Related Knee Pain

Osteoarthritis (OA) of the knee is a prevalent cause of chronic pain and disability, particularly affecting women. While traditionally attributed to chronic wear and tear, recent evidence highlights multifactorial pathogenesis involving low-grade inflammation and neoangiogenesis. Current therapeutic options include physical therapy, pharmacotherapy, and total knee arthroplasty (TKA). However, a subset of patients remain symptomatic despite conservative measures, necessitating the development of minimally invasive interventions. Genicular artery embolization (GAE) emerges as a promising option, targeting neovascularization and inflammatory processes in OA. This paper reviews the pathophysiological basis, patient selection criteria, procedural details, and outcomes of GAE. Notably, GAE demonstrates efficacy in relieving knee pain and improving function in patients refractory to conventional therapy. While further research is warranted to elucidate its long-term outcomes and compare it with existing modalities, GAE represents a novel approach in the management of symptomatic knee OA, potentially delaying or obviating the need for surgical intervention. Here, we synthesize the relevant literature, technical details of the procedure, and future perspectives. Moreover, the success of GAE prompts the exploration of transarterial embolization in other musculoskeletal conditions, underscoring the evolving role of interventional radiology in personalized pain management strategies.

Genicular Artery Embolization: Embolic Material and Imaging Review

Osteoarthritis (OA) of the knee is a degenerative condition impacting numerous individuals globally. Genicular artery embolization (GAE) has emerged as an effective minimally invasive therapy for managing medically refractory OA-related pain in patients who are not eligible for surgery. This intervention works by disrupting the inflammatory and neoangiogenic pathways that contribute to pain. The efficacy of GAE has been demonstrated in various clinical trials, yielding promising results. This review aims to explore recent advancements in the embolic materials used during GAE, examining their properties and potential benefits. Additionally, it will describe the use of pre-, intra-, and postprocedural imaging-particularly magnetic resonance imaging and other modalities-to optimize GAE outcomes.

Selective Genicular Artery Embolization in the Management of Osteoarthritic Knee Pain-A Narrative Review

Many people with pain from osteoarthritis (OA) of the knee are either not ready for surgery or may never be surgical candidates. Genicular artery embolization (GAE) is a new proposed management for those with pain despite maximum medical management. It has historically been used to manage recurrent spontaneous haemarthrosis following total knee replacement, but newer studies are showing a positive effect in managing pre-arthroplasty knee OA. The goal of this review is to summarise current and relevant literature from searches of computerised databases and relevant journals, and analyse their results. Studies included show that GAE has promising outcomes in managing mild to moderate OA knee pain in those who have exhausted at least 3 months of conservative therapy. Most studies show improvements in VAS pain and PROM scores (including KOOS, and/or WOMAC). Minimal adverse effects have been associated in up to two years of follow up, the majority of which are self-resolving. The article précises a concise general procedural technique for performing GAE, as well as comparing and contrasting different embolic agents that may be utilised. GAE shows promising outcomes in management of mild to moderate OA knee pain. In the future, there will need to be higher volume studies to determine effectiveness, suitable candidates, and other potential adverse effects.

Genicular Artery embolisation in Patients with Osteoarthritis of the Knee (GENESIS) Using Permanent Microspheres: Long-Term Results

PURPOSE

To report the 2-year follow-up of patients with mild-to-moderate knee osteoarthritis (OA) treated with genicular artery embolisation (GAE) as part of the GENESIS study.

MATERIALS AND METHODS

Forty-six patients, median age = 60 (45-83) underwent GAE using permanent microspheres (100-300 μm). Technical success was defined as embolisation of the targeted genicular arteries. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analogue Scale (VAS) (0-100 mm) were recorded at baseline, 6 weeks, 3 months, 1, 2 years. Contrast-enhanced MRI knee scans were acquired at baseline and 1 year, and evaluated with the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Functional MRI brain imaging and psychometric assessments were undertaken to investigate correlation between neuropsychological phenotypes and clinical outcome. Adverse events were recorded prospectively.

RESULTS

Technical success was achieved in forty patients (87%). Mean VAS improved from 58.63 (SD = 20.57, 95% CI 52.7-65.5) at baselines to 37.7 at 2-years (SD = 26.3, 95% CI 27.0-47.5). Whole and subgroup KOOS were significantly improved at each timepoint with associated reductions in analgesia usage. WORMS analysis demonstrated significant reduction in synovitis (p < 0.05) with no cases of osteonecrosis. Self-limiting skin discolouration occurred in four patients. A self-limiting groin haematoma and single case of deep-vein thrombosis due to immobilisation were also recorded. Nine patients subsequently underwent knee arthroplasty with no additional operational complexities identified. Neuropsychometric assessment elucidated a correlation between baseline catastrophising and greater reduction in pain post GAE.

CONCLUSION

GAE is a safe intervention for mild-moderate knee osteoarthritis, with sustained efficacy at 2 years. These results are promising and justify ongoing controlled trials.

Comparative Analysis of Transpedal and Transfemoral Access During Genicular Artery Embolization for Knee Osteoarthritis

PURPOSE

This retrospective study aimed to compare the efficacy and safety of transpedal access (TPA) with transfemoral access (TFA) in Genicular Artery Embolization (GAE).

MATERIALS AND METHODS

60 patients who underwent GAE between January and June 2023, were recruited and outcomes were compared between the TFA (n = 37) and TPA (n = 23) groups. Technical and clinical success rates, complications, and patient-reported outcomes were assessed.

RESULTS

All patients attained a 100% technical success rate, which was defined as the successful selective catheterization and embolization of at least one feeding artery to the knee joint, without encountering any major complications. Minor complications, observed in 12/60 patients (20%), were predominantly manifested as a transient skin discoloration. The TPA group had a comparatively higher (p = 0.008) rate of minor complication than the TFA group. Notably, TPA was associated with a longer duration of the procedure (p = 0.013), duration of fluoroscopy (p = 0.004), increased total air kerma (p = 0.037), dose-area product values (p = 0.021), and a greater incidence of vasospasm (p = 0.018) than TFA. However, TPA patients reported shorter recovery times and less post-procedural discomfort, especially reduced back pain due to postinterventional bedrest (p < 0.001). At the 3-month follow-up, the clinical success rate was similar between the two groups (p = 0.905).

CONCLUSION

TFA is the safer and faster method for GAE, offering fewer complications and reduced radiation exposure. For patients with challenging groin anatomies, however, TPA may provide a valuable alternative.

Transarterial microembolization for the management of refractory chronic joint pain in osteoarthritis

Osteoarthritis (OA) is a chronic degenerative disease significantly impacting both patient quality of life and socioeconomics. Traditional treatment options, including pharmacological and surgical interventions, are often limited. Advancements in our understanding of the pathological mechanisms behind OA indicate the involvement of pathological angiogenesis. Transarterial microembolization (TAME), a minimally invasive radiological procedure, may present an innovative therapeutic approach. This review aims to consolidate current knowledge and experiences regarding TAME as a therapeutic modality for alleviating chronic joint pain associated with OA. It explores the role of TAME, focusing on its indications, patient selection, clinical outcomes, and future perspectives. Potential complications and associated risks are systematically addressed, alongside proposed strategies for risk mitigation and effective management.The presented patient cases originate from our institution, supplemented by a thorough review of relevant literature retrieved from PubMed.TAME represents a promising therapeutic approach, providing relief from the burden of joint diseases and substantially enhancing patient quality of life. Clinical outcomes emphasize the efficacy and safety of TAME in mitigating pain and improving functional capabilities in patients with chronic joint pain associated with OA. With mounting evidence of its therapeutic benefits and applicability to numerous joint-related pathologies, TAME offers a valuable addition to the arsenal of treatments for these conditions. · TAME is an innovative therapy for treating chronic joint pain related to OA.. · TAME is a technically challenging minimally invasive intervention requiring a high level of expertise.. · Understanding the challenges and complications of TAME can reduce risk and enhance procedural outcomes.. · Wilms LM, Jannusch K, Weiss D et al. Transarterial microembolization for the management of refractory chronic joint pain in osteoarthritis. Fortschr Röntgenstr 2024; DOI 10.1055/a-2288-5743.

Challenges and complications and their management of the transarterial microembolization for chronic musculoskeletal pain

Transarterial microembolization (TAME) is an increasingly well-known novel and minimally invasive treatment option for painful chronic musculoskeletal diseases that is gaining popularity. Although the safety and effectiveness of TAME have been established, limited knowledge of intraarticular and musculocutaneous arterial anatomy may lead to challenges and complications. This article aims to present cases illustrating these challenges and complications, based on multicenter experiences and a comprehensive literature review. Furthermore, the article also provides preventive tips, solutions, and follow-up strategies to reduce the learning curve for interventional radiologists and facilitate familiarity with post-TAME follow-up images for diagnostic radiologists. CLINICAL RELEVANCE STATEMENT: This article illustrates the intra- and post-interventional complications of transarterial microembolization (TAME) through detailed pictorial reviews, including how to distinguish them from normal angiographic findings. It provides strategies for their prevention, management, and follow-up, which can further improve clinical outcomes. KEY POINTS: • Transarterial microembolization for chronic musculoskeletal pain may result in intrainterventional challenges (IIC) and postinterventional complications (PIC), and their importance may be underestimated. • The intrainterventional challenges include microarterial perforation, arterial dissection, and catheter tip fracture, whereas postinterventional complications include tissue ischemia-related complications, puncture site hemorrhage, and arterial injury. • Being familiar with the intrainterventional challenges and postinterventional complications may help minimize the procedure risk and improve outcomes.

Safety and Efficacy of Genicular Artery Embolization for the Treatment of Knee Pain Secondary to Osteoarthritis-Initial Indian Experience

Background  Osteoarthritis (OA) is the commonest form of arthritis with pain and disability as hallmark symptoms. Despite various nonpharmacologic, pharmacologic, and surgical approaches, pain control may be hard to achieve. Over the last few years, few studies have been conducted on managing knee OA using novel endovascular genicular artery embolization (GAE) with varied outcomes. No such study has been reported in India yet to the best of our knowledge. Purpose  The main aim of this article was to evaluate the efficacy and safety of transcatheter GAE in relieving knee pain in patients with mild-to-moderate OA. Materials and Methods  Ten patients with radiographic knee OA and moderate-to-severe pain refractory to conservative therapy were enrolled in a prospective observational study. GAE was performed with 100 to 300-μm spherical particles. Patients were assessed with magnetic resonance imaging at the baseline. Visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to assess pain and disability respectively at the baseline, 1 month, and 3 months. Clinical success was asserted by the downstaging of VAS and WOMAC scores. Adverse events were recorded at all-time points. Descriptive and inferential statistics have been performed using SPSS. A p -Value less than 0.05 was considered statistically significant. Results  Embolization of at least 1 genicular artery was achieved in all the patients (100%). Clinical success was demonstrated in 08 (80%) of the patients. Median VAS reduced from 07 at baseline to 3.5 at 3-month follow-up ( p  < 0.001). Median WOMAC score improved from 53 to 23.50 at 3-month follow-up ( p  < 0.001). Minor complications were seen in two patients in the form of puncture site hematoma and mild petechial spots over the knee. Conclusion  Our pilot study demonstrates GAE as a safe and efficacious procedure to treat knee pain secondary to OA. Further randomized comparative studies with a larger sample size are needed to determine the true treatment effect versus the placebo effect.

Value of Edema-like Marrow Signal Intensity in Diagnosis of Joint Pain: Radiologists' Perspective

Musculoskeletal pain is a significant contributor to disability. The mechanism and target of the treatment should be optimized by imaging, but currently no accepted gold standard exists to image pain. In addition to end-organ pathology, other mediators also contribute to nociception, such as angiogenesis, axonal extension, immunologic modulation, and central sensitization. Recent research indicates that local inflammation is a significant contributor to pain in the extremities; therefore, we focus here on edema-like marrow signal intensity (ELMSI). We examine both the relevance of ELMSI for pain and novel imaging techniques.

Musculoskeletal Embolotherapy

Painful articular musculoskeletal (MSK) conditions are common, debilitating and sometimes difficult to treat. Transcatheter embolisation may offer an alternative way to manage the pain associated with these conditions, but the field is still in its infancy. To date, the most commonly studied indication is knee osteoarthritis, but the technique has been trailed in multiple other tissue beds, including for adhesive capsulitis and tendinopathies. Whilst early results appear promising, the existing studies are mostly open-labelled and non-randomised; there is a need for high-quality evidence to robustly assess the procedures efficacy. In this review, we set out to evaluate the current evidence underlying the pathophysiology and mechanism of action of embolisation; discuss the technical aspects of the procedure including embolic selection, and appraise the published clinical outcomes and adverse effects. Finally, we discuss the future directions and research priorities in this rapidly developing field.

Evaluating the Safety and Effectiveness of Quick-Soluble Gelatin Sponge Particles for Genicular Artery Embolization for Chronic Knee Pain Associated with Osteoarthritis

PURPOSE

To evaluate the effectiveness and safety of genicular artery embolization (GAE) using quick-soluble gelatin sponge particles (QS-GSPs) to alleviate chronic knee pain associated with osteoarthritis.

MATERIALS AND METHODS

This retrospective study included 71 patients (97 procedures, including 26 patients for both knees) who underwent GAE to treat osteoarthritic knee pain between August 2019 and January 2022. QS-GSPs were used for all the procedures. Technical success was defined as the embolization of at least 1 feeding artery. Clinical outcomes were evaluated using a 10-point visual analog scale (VAS). Clinical success was defined as a decrease in the VAS score of >50%.

RESULTS

The technical success rate was 100% (97 of 97). The mean VAS scores at baseline, immediately after TAE, and at 1 day, 1 week, 1 month, 3 months, and 6 months after TAE were 6.3, 4.3, 5.0, 3.0, 2.9, 2.9, and 2.8, respectively. The clinical success rate was 72% (70 of 97 patients) at 6 months. No major adverse events were reported, and temporary skin color change (50.5%, 49 of 97) and hematoma at the puncture site (10.3%, 10 of 97) were observed.

CONCLUSIONS

GAE using QS-GSPs had a high technical success rate and was considered safe. Clinical outcomes using QS-GSPs were comparable with those of existing materials.

Transcatheter embolisation in chronic musculoskeletal disorders

Chronic musculoskeletal conditions affect millions of patients worldwide resulting in disability, reduced quality of life, and have a profound economic impact on the individual and society. Current treatment strategies fail patients who have not responded to conservative management but are not surgical candidates. Over the last decade, transcatheter embolisation has emerged as a potential treatment for these difficult to treat patients. By exploiting pathological neovascularisation within conditions such as knee osteoarthritis, adhesive capsulitis, and tendinopathy, embolisation has been used to improve patients' pain and function. This review explores the rationale for musculoskeletal transcatheter embolisation, illustrating the technique, and latest evidence for the most common procedures.

Genicular Artery Embolization for Knee Osteoarthritis: A Comprehensive Review

» Genicular artery embolization (GAE) is a promising treatment option for patients with knee osteoarthritis who are unresponsive to nonsurgical treatments and not yet candidates for surgery.» Current evidence supports the effectiveness of GAE in reducing pain and synovitis, with few reported major adverse events.» The cost-effectiveness and long-term results of GAE compared with other treatment options require further investigation.» Limitations of existing studies include small sample sizes, single-center trials, and lack of comparison between embolic agents and other treatments.» Future research should focus on larger, multicenter trials with longer follow-up periods and head-to-head comparisons with alternative treatment modalities to establish the role of GAE in the management of knee osteoarthritis.

Short-Term Effects of Genicular Artery Embolization on Symptoms and Bone Marrow Abnormalities in Patients with Refractory Knee Osteoarthritis

PURPOSE

To evaluate the short-term outcomes of genicular artery embolization (GAE) for knee osteoarthritis (OA) with and without bone marrow lesion (BML) and/or subchondral insufficiency fracture of the knee (SIFK).

MATERIALS AND METHODS

This single-institution prospective observational pilot study analyzed 24 knees in 22 patients with mild to moderate knee OA, including 8 knees without BML, 13 knees with BML, and 3 knees with both BML and SIFK. The area and volume of BMLs on magnetic resonance images were measured before and after GAE. Baseline and postoperative pain and physical function were assessed using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

RESULTS

GAE significantly reduced the BML area and volume 3 months after embolization in the knees with BML (both P < .0005). GAE significantly decreased the VAS scores at 3 and 6 months after embolization in patients without BML (both P = .04) and those with BML (both P = .01). GAE also lowered the WOMAC scores 3 months after embolization in patients without and with BML (P = .02 and P = .0002, respectively). However, GAE did not significantly alter the BML area and volume (both P = .25), VAS scores (P = 1.00), and WOMAC scores (P = .08) in patients with BML and SIFK at 3 months after GAE.

CONCLUSIONS

This observational pilot study suggested that GAE effectively reduces the BML area and volume and improves pain and physical function in patients with knee OA accompanied by BML but is inefficacious in those with both BML and SIFK.

The short-to-midterm outcomes of geniculate artery embolization for mild-to-moderate osteoarthritis of the knee: a systematic review

Background

Geniculate Artery Embolization (GAE) is a novel, minimally-invasive treatment for mild to moderate Osteoarthritis (OA) associated with musculoskeletal pain.

Purpose

To investigate the outcomes of GAE in patients with mild to moderate OA of the knee using a Quantitative-analysis of the available literature.

Methods

The PubMed, EMBASE and Cochrane databases were searched for GAE-related studies. Qualitative and quantitative analyses were performed following PRISMA-guidelines. Quantitative-analysis was performed using windows based 'MedCalc-Statistical-Software version 19.6.1 (2020). Statistical analysis was performed in Stata-IC-13.1(Stata corp-USA). Quantitative-analysis was done using the random-effects model, and the Standardized-Mean-Differences (SMD) were calculated.

Results

After a full-text review, 13 studies with 399 knees (345-patients) were included in the qualitative synthesis, 10 were included in the quantitative synthesis. The total WOMAC score improved by a [SMD (95% CI)] of 3.46 points (1.27, 5.65), 3.50 (1.28, 5.71), 3.77 (0.58, 6.96), 5.46 (1.59, 9.33), 2.96 (-0.93, 6.85) compared to baseline at 1, 3, 6, 12, 24 months respectively. The VAS score improved by 2.06 (1.35, 2.76), 2.13 (1.39, 2.87), 2.36 (1.85, 2.90), 2.09 (0.91, 3.28) compared to baseline at 1, 3, 6, 12 months respectively. The Pain WOMAC score improved by SMD 2.97 (0.51, 5.43), 3.77 (0.58, 6.96), 2.27 (0.31, 4.22), 2.27 (0.31, 4.22) compared to baseline at 1, 3, 12, 24 months, respectively.

Conclusion

There was a statistically significant change from baseline in all outcome measures after GAE. GAE is a safe and effective method for pain control in mild to moderate OA-associated knee pain in the short and medium term.

Genicular Artery Embolization as a Treatment for Osteoarthritis Related Knee Pain: A Systematic Review and Meta-analysis

OBJECTIVE

Genicular artery embolization (GAE) is a minimally invasive therapy for symptomatic osteoarthritis (OA) in patients with knee pain refractory to conservative management. The purpose of this study was to evaluate evidence on the effectiveness of GAE for OA related knee pain as part of a systematic review and meta-analysis.

MATERIALS AND METHODS

Using Embase, PubMed, and Web of Science, a systematic review was performed to identify studies evaluating treatment of knee OA with GAE. The primary outcome measure was change in pain scale score at 6 months. A Hedge's g was computed as a measure of effect size, selecting Visual Analog Scale (VAS) first if available and Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index if VAS was not available.

RESULTS

After screening titles, abstracts, and the full text, 10 studies met inclusion criteria. A total of 351 treated knees were included. Patients who underwent GAE demonstrated declines in VAS pain scores at 1 month {- 34 points [95% CI (- 43.8, - 24.6)], 3 months {- 30 points [95% CI (- 41.7, - 19.2)], 6 months {- 41 points [95% CI (- 54.0, - 27.2)], and 12 months {- 37 points [95% CI (- 55.0, - 18.1)]. Hedges' g from baseline to 1, 3, 6, and 12 months, was {- 1.3 [95% CI (- 1.6, - 0.97)]}, {- 1.2 [95% CI (- 1.54, - 0.84)]}, {- 1.4 [95% CI (- 2.1, - 0.8)]}, and {- 1.25 [95% CI (- 2.0, - 0.6)]}, respectively.

CONCLUSION

GAE provides durable reductions in pain scores for patients suffering with mild, moderate, and severe OA.

Genicular Artery Embolization Technique

Genicular artery embolization (GAE) is a safe and effective treatment for knee pain related to osteoarthritis, however there are several aspects of the procedure technique which may be unique. Familiarity with procedural steps, arterial anatomy, embolic endpoints, technical challenges, and potential complications is imperative for good clinical practice and outcomes. The success of GAE depends on correctly interpreting angiographic findings and variable anatomy, navigating small and acutely angled arteries, recognizing collateral supply, and avoiding non-target embolization. The procedure can potentially be performed for a wide range of patients with knee osteoarthritis. When effective, pain relief can be durable for many years. When done meticulously, adverse events from GAE are uncommon.

Genicular artery embolization for treatment of knee osteoarthritis pain: Systematic review and meta-analysis

Objective

Genicular artery embolization (GAE) is a novel, minimally invasive procedure for treatment of knee osteoarthritis (OA). This meta-analysis investigated the safety and effectiveness of this procedure.

Design

Outcomes of this systematic review with meta-analysis were technical success, knee pain visual analog scale (VAS; 0-100 scale), WOMAC Total Score (0-100 scale), retreatment rate, and adverse events. Continuous outcomes were calculated as the weighted mean difference (WMD) versus baseline. Minimal clinically important difference (MCID) and substantial clinical benefit (SCB) rates were estimated in Monte Carlo simulations. Rates of total knee replacement and repeat GAE were calculated using life-table methods.

Results

In 10 groups (9 studies; 270 patients; 339 knees), GAE technical success was 99.7%. Over 12 months, the WMD ranged from -34 to -39 at each follow-up for VAS score and -28 to -34 for WOMAC Total score (all p ​< ​0.001). At 12 months, 78% met the MCID for VAS score; 92% met the MCID for WOMAC Total score, and 78% met the SCB for WOMAC Total score. Higher baseline knee pain severity was associated with greater improvements in knee pain. Over 2 years, 5.2% of patients underwent total knee replacement and 8.3% received repeat GAE. Adverse events were minor, with transient skin discoloration as the most common (11.6%).

Conclusions

Limited evidence suggests that GAE is a safe procedure that confers improvement in knee OA symptoms at established MCID thresholds. Patients with greater knee pain severity may be more responsive to GAE.

Mechanism of action of genicular artery embolization in a rabbit model of knee osteoarthritis

OBJECTIVES

To establish a rabbit osteoarthritis model for genicular artery embolization (GAE) experiments and to investigate the cellular mechanism of action of this novel procedure for interventional radiologists.

METHODS

Rabbit knee osteoarthritis was surgically modeled by anterior cruciate ligament transection and medial partial meniscectomy of the bilateral hindlimbs followed by 10 weeks of incubation. Rabbits exhibiting synovitis on magnetic resonance imaging were randomly divided into two groups: the bilateral GAE group and the control (sham procedure) group. Four weeks later, the rabbits' mobility (moving time, sec/10 min) and the histopathological features of each knee were assessed, and inter-group differences were evaluated using Student's t-test and ordinal/linear logistic models with generalized estimating equations.

RESULTS

Osteoarthritis modeling and endovascular procedures were successful in 15 of 20 rabbits (8 and 7 in the GAE and control groups, respectively). There was no significant difference in moving times between the two groups (p = .958). The degree of structural cartilage damage was similar in both groups (p = .780). However, the synovial proliferation (p = .016), synovial hypertrophy (p < .001), and villous hyperplasia of the synovial stroma (p = .002) scores were significantly lower in the GAE group than in the control group. The CD3+ cell density (p = .018) and CD3 + cell-infiltrated area (p = .019) were also significantly lower in the GAE group than in the control group.

CONCLUSION

GAE can limit inflammatory processes in the synovium of osteoarthritis-affected knees.

KEY POINTS

Surgical transection of the anterior cruciate ligament and medial partial meniscectomy of rabbit knees provides a useful animal model for research of genicular artery embolization. Osteoarthritic knees treated by genicular artery embolization showed milder synovial proliferation (p = .016), synovial hypertrophy (p < .001), and villous hyperplasia of the synovial stroma (p = .002) than the untreated knees. Osteoarthritic knees treated by genicular artery embolization presented lower CD3+ cell density (p = .018) and CD3+ cell-infiltrated area (p = .019) in the synovium than the untreated knees.

Transcatheter Arterial Embolization for Alleviating Chronic Musculoskeletal Pain and Improving Physical Function: A Narrative Review

Chronic musculoskeletal pain imposes immense suffering and diminishes the quality of life for millions of patients worldwide; the pain persists despite the use of standard conservative treatments. Increases in our understanding of the pathophysiological mechanisms underlying musculoskeletal disorders indicate the involvement of inappropriate angiogenesis. Accordingly, the resulting neovessels are the target of emerging treatments for chronic musculoskeletal pain, including transarterial embolization. The use of this noninvasive procedure to treat pain refractory to standard therapy in a variety of musculoskeletal conditions is the focus of numerous recent investigations. Here, we describe the pathophysiological indications for the use of transarterial embolization and summarize the findings of studies investigating its use in a variety of histopathological conditions and anatomical sites.

Deconstruction of Knee Cartilage Injury in Athletes Using MR Images Based on Artificial Intelligence Segmentation Algorithm

The knee joint is the second largest joint in the human body, with a wide range of functional activities and strong support for the human body. Moreover, the cartilage of the knee joint is hyaline cartilage, which is relatively brittle, so it is most vulnerable to trauma. In clinical work, the damage of articular cartilage is a disease with a high rate of orthopedic visits. In this paper, all the experimental group cases included in the observation were patients with acute articular cartilage injury or OA diagnosed by knee arthroscopy. All experimental groups and control groups did not have any strenuous exercise one day before MRI (magnetic resonance imaging), and they sat for 30 minutes before the examination. Conventional scanning sagittal FSE-T1WI, FSE-T2WI, FS-FSE-T1WI, FS-FSE-T2WI, FS-PDWI, and coronal FS-PDWI sequence. In the normal control group, after the T2 color map was generated in the workstation, the articular cartilage was divided on the midsagittal plane, and the patellar cartilage and tibial plateau were roughly divided into upper, middle, lower and anterior, middle, and posterior thirds. In order to ensure the maximum comparability of the results, an artificial intelligence segmentation algorithm is used to divide the region of interest equally, and the central part of each partition is selected as much as possible for measurement. The T2 values of the three partitions of each cartilage were measured one by one and averaged. For the comparison results of T2 value of cartilage in the same part: according to patellar cartilage, femoral cartilage, and tibial cartilage, the P values are 0.973, 0.150, and 0.525, respectively. Therefore, early detection and early treatment of articular cartilage injury are of great significance to the performance of athletes' competition level and the extension of sports life.

Transcatheter arterial embolization for benign chronic inflammatory joint pain: a systematic review and meta-analysis

PURPOSE

To evaluate the efficacy and safety of transcatheter arterial embolization for the treatment of chronic inflammatory joint pain via a systematic review and meta-analysis.

MATERIALS AND METHODS

The MEDLINE and EMBASE databases were searched for studies reporting outcomes in patients with chronic inflammatory joint pain treated with transcatheter arterial embolization. Meta-analyses of pain score changes, changes in proportions of patients on analgesic medications, range of motion changes, technical success rates, and adverse events rates were performed. Subgroup analyses were conducted with respect to pain site (knee vs. shoulder).

RESULTS

Fourteen observational studies, including 346 patients, were reviewed. The pooled technical success rate was 95.8%, and no major adverse events were observed. The pooled mean difference in pain score at 1 week; 1, 3, and 6 months; and 1 year were 3.1, 4.0, 4.2, 5.1, and 5.5, respectively. Subgroup analysis demonstrated that shoulder embolization was associated with greater reduction of pain than knee embolization at 3 and 6 months (p<0.001 and p=0.018, respectively), whereas there was no significant difference in this regard between the sites at 1 month (p=0.734). The pooled proportions of patients on analgesic medication at baseline, 1, 3, 6, and 12 months were 81.1%, 36.3%, 42.3%, 28.2%, and 22.4%, respectively. The pooled estimated increases in range of motion among patients who underwent shoulder embolization were 55.6° for anterior elevation and 64.7° for abduction.

CONCLUSION

Transcatheter arterial embolization is an effective and safe therapeutic option for patients with chronic inflammatory joint pain.

Current Status of Trans-Arterial Embolization in Pain Management of Musculoskeletal Inflammatory Conditions - An Evidence-Based Review

OBJECTIVE

To summarize the literature on trans-arterial embolization in inflammatory musculoskeletal conditions, focusing on efficacy and safety.

MATERIALS AND METHODS

PRISMA guidelines were followed. A systematic literature search revealed 19 studies, with a total of 394 participants, eligible for inclusion.

RESULTS

The included studies consisted of case reports/series and non-randomized interventional studies, with knee osteoarthritis and adhesive capsulitis of the shoulder as the most frequent conditions. In all studies except one, pain was reduced up to four years after treatment. All adverse events were transient. Due to high heterogeneity, meta-analysis was not possible.

CONCLUSION

The included early studies showed encouraging results regarding efficacy and safety. However, randomized, placebo-controlled trials are warranted.