A Pilot Study of an Expanded Genicular Nerve Radiofrequency Ablation Protocol for the Treatment of Chronic Knee Pain

Dear Editor: Fluoroscopically guided genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for patients suffering from chronic knee pain [1,2]. With increasing utilization, the anatomic basis of GNRFA has appropriately received increased scrutiny. GNRFA reduces pain by interrupting nociceptive pain signals originating from the knee joint. Traditionally, this procedure has targeted the superomedial (SMGN), superolateral (SLGN), and inferomedial (IMGN) genicular nerves [1]. However, the anatomic study by Tran et al. significantly added to the collective knowledge of genicular nerve anatomy by identifying additional nerves and demonstrating significant variability in nerve location [3]. They found the superolateral quadrant of the anterior knee is innervated by the SLGN, the common fibular nerve, and the nerves to the vastus lateralis (NVL) and vastus intermedius (NVI); the inferolateral quadrant by the recurrent fibular and inferolateral genicular (ILGN) nerves; the superomedial quadrant by the nerve to the vastus medialis (NVM), the NVI, and the SMGN; and the inferomedial quadrant by the IMGN.