Disclosures: Matthew Cowling, DO: Nothing to disclose

Case Description: The patient sustained an injury in which a pile hammer fell on him at work crushing his knee and requiring him to undergo a complete left knee reconstruction, including ACL and PCL repair. He has had constant pain since the accident and has had tried physical therapy, gabapentin, pregabalin, diclofenac sodium gel, and acetaminophen, without any substantial relief. He described his pain as an achy pain when seated and a sharp intermediate stabbing pain when standing up. The pain was a 10/10 in severity at its worst. On physical examination, strength was 5/5 in the lower extremities. Reflexes were 1+ in the patella and achilles. Sensation was diminished in the left lateral knee into the lateral calf. There was pain with palpation over medial and lateral joint lines in the left knee, with mild crepitus during knee extension. No effusion was noted. X-ray imaging of the left knee revealed post-surgical changes, with only mild signs of arthritis.

Setting: Pain clinic

Patient: A 53-year-old male with 5 years of chronic left knee pain.

Assessment/Results: The patient underwent genicular nerve blocks, followed by genicular radiofrequency ablation (RFA), which resulted in lasting pain relief. One year after genicular nerve block/RFA, the patient reported his pain as a 4/10 in severity, a 60% reduction from his pain level prior to the procedure.

Discussion: Genicular nerve block and genicular RFA ablation are procedures which have shown promise in both pain reduction and functional improvement for knee osteoarthritis. There are no studies evaluating the efficacy of this procedure for patients with non-osteoarthritis related knee pain, especially among the younger population. 

Conclusion: Genicular nerve block followed by RFA may be a viable treatment option for patients with non-osteoarthritis related chronic knee pain, particularly among patients who have not achieved improvement through conservative measures.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/genicular-radiofrequency-ablation-for-chronic-knee-pain-status-post-acl-and-pcl-repair-a-case-report/