c. Knee joint interventions

Knee Intra-Articular Injection and Genicular Nerve Block and Ablation

The knee is a complex synovial joint composed of several structures and has three functional compartments: the femoropatellar articulation, which is in front of the femur with the patellar groove that slides during movement, and the medial and lateral femorotibial articulations, connecting the femur with the tibia. Within the joint capsule, which contains synovial fluid, there is a synovial and fibrous membrane separated by adipose tissue. In front, the synovial membrane adheres to the cartilage's edge over both the femur and the tibia, but in the femur, it extends the joint space proximally via the suprapatellar bursa or recess. This bursa prevents impingement during extension of the joint. Posteriorly, the synovial membrane attaches to the edges of the two femoral condyles, creating extensions similar to the anterior recess. Between these two extensions, the synovial membrane forms a pouch inwardly in front of the two cruciate ligaments at the center of the joint.

Knee joint interventions, particularly in the elderly and athletes, are often necessary due to pain, arthritis, and injuries. Two of the treatment methods for knee pain are "knee intra-articular injections" and "radiofrequency ablation." These methods are used to alleviate knee pain and improve the quality of life for patients.

 

Who are the candidates for knee joint interventions?

1. Patients with symptomatic knee osteoarthritis unresponsive to conservative treatments, who have undergone surgery or are candidates for it.
2. Patients for whom a knee prosthesis is not beneficial.
3. Patients who cannot undergo surgery due to medical issues.
4. Patients who are afraid of surgery.
5. Patients who have previously undergone genicular nerve radiofrequency ablation and found it effective.

In which patients are knee joint interventions contraindicated?

1. Pregnancy
2. Acute knee trauma
3. Unstable knee joint
4. Psychological disorders including Diabetes
5. Local or systemic infection
6. Coagulopathy
7. Recent myocardial infarction
8. Patient refusal

Knee Intra-Articular Injections

These injections are administered directly into the knee joint and can include:

1. Corticosteroid Injections: These help to relieve inflammation and pain in the inflamed and swollen joint.
2. Hyaluronic Acid Injections: These injections mimic the "joint fluid" in the knee, increasing lubrication and reducing pain.
3. Platelet-Rich Plasma (PRP) Injections: This treatment uses platelets derived from the patient's own blood, which can promote the natural healing process and reduce pain.

 

Radiofrequency Thermocoagulation

Radiofrequency Thermocoagulation works by applying radiofrequency energy to nerves that cause pain. Here are some details:

1. Conventional Radiofrequency (CRF): This treatment "heats" the nerves to temporarily block pain signals.
2. Pulsed Radiofrequency (PRF): This newer technique applies short "pulses" of energy at a lower temperature to nerves that manage pain.
3. Cold Plasma Radiofrequency: This technique uses a plasma field to treat targeted nerves without causing damage, to block pain signals.

All these methods should be performed by physicians trained in algology (pain management).