Ultrasound-guided radiofrequency ablation of genicular nerves: a novel 5-nerve protocol–pilot study

Objectives: Genicular nerve radiofrequency ablation (RFA) efficacy for knee osteoarthritis (OA) remains debated. This prospective pilot study evaluated the feasibility and outcomes of a novel 5-nerve ultrasound-guided protocol targeting: Superior-Medial (SMGN), Superior-Lateral (SLGN), Inferior-Medial (IMGN), Inferior-Lateral (ILGN) Genicular Nerves and Recurrent Fibular Nerve (RFN). Methods: Nineteen patients were enrolled. Feasibility was assessed through protocol adherence and safety (adverse events rate). Primary outcomes were pain (Numerical Rating Scale - NRS) and function (Western Ontario and McMaster Universities Osteoarthritis Index - WOMAC) defining responders as ≥50% improvement. Secondary assessments included Environmental Quality of Life Scale (EQoL-5), 6-Minute Walk Test (6MWT), Timed-Up-and-Go (TUG), and Medical Research Council (MRC) scale at 1 and 3 months. Results: Significant improvements occurred in NRS (p < 0.001), WOMAC (p < 0.001), and EQoL-Index (p = 0.003); responder rate was 63.2% (n = 12/19). One patient withdrew after T1 due to dissatisfaction; no study attrition or adverse events (notably motor deficits) occurred. Baseline 6MWT >200 m associated with treatment response (p = 0.048), though small sample size limits generalizability. Conclusions: This 5-nerve protocol demonstrated clinical plausibility and safety. Lack of a control group precludes definitive attribution of improvements to RFA over placebo. Robust RCTs comparing 3-nerve vs. 5-nerve protocols are mandatory before clinical implementation.