1447 - Genicular Nerve Radiofrequency Ablation for Chronic Knee Pain: A Meta-Analysis of Low-Risk Bias Trials

Objectives: Genicular nerve radiofrequency ablation (gRFA) is a widely used treatment for chronic knee pain, but its long-term efficacy remains unclear. While prior meta-analyses included heterogeneous studies, this systematic review and meta-analysis focuses on randomized controlled trials (RCTs) with low risk of bias to provide higher-quality evidence.

Design: RCTs with low risk of bias used proper randomization, allocation concealment, and blinding. This review compared gRFA (conventional, cooled, pulsed, bipolar) to non-gRFA treatments (e.g., sham, steroid, PRP, hyaluronic acid, lidocaine block, oral meds). Primary outcomes were VAS and WOMAC scores. Secondary and tertiary analyses assessed lesion size, prognostic blocks, industry sponsorship, and study location. Data were pooled using a random-effects model, with heterogeneity assessed via forest plots and Higgins I².

Results: Thirteen RCTs (1,018 adults) were included: 511 received gRFA, and 507 underwent non-gRFA interventions. Pooled VAS scores showed gRFA had significantly lower pain at 3 months (2.67 vs. 4.82; mean difference -1.8, 95% CI: -2.96 to -0.64, I² = 97%), but not at 6 or 12 months. Secondary subgroup analyses revealed no significant differences based on lesion size and prognostic blocks. Tertiary subgroup analyses showed that studies conducted outside the USA and those with industry sponsorship demonstrated a significant reduction in 3-month pain scores, whereas studies conducted in the USA and non-industry-sponsored studies did not. Regarding adverse events, one study documented a single case of significant lower limb swelling following the gRFA procedure, whereas the remaining trials either reported no adverse events (n=10) or did not mention adverse events (n=3).

Conclusions: This study shows that gRFA offers short-term pain relief at 3 months but does not improve function or provide sustained pain reduction. Unlike earlier reviews, this analysis of low-bias RCTs does not support routine use of gRFA for long-term knee pain management due to study heterogeneity, inconsistent outcomes, and limited long-term efficacy.