We report a new technique for pulsed radiofrequency (PRF) of the entire nerve supply
of the knee as an option in treating osteoarthritis (OA) of knee. We targeted both
sensory and motor nerves supplying all the structures around the knee: joint, muscles,
and skin to address the entire nociception and stiffness leading to peripheral and central
sensitization in osteoarthritis. Ten patients with pain, stiffness, and loss of function in
both knees were treated with ultrasonography (USG) guided PRF of saphenous, tibial,
and common peroneal nerves along with subsartorial, peripatellar, and popliteal plexuses.
USG guided PRF of the femoral nerve was also done to address the innervation of the
quadriceps muscle. Assessment of pain (Numerical Rating Scale [NRS], pain DETECT, knee
function [Western Ontario and McMaster Universities Osteoarthritis Index- WOMAC])
were documented pre and post PRF at 3 and 6 months. Knee radiographs (KellgrenLawrence [K-L] grading) were done before PRF and one week later. All the patients showed
a sustained improvement of NRS, pain DETECT, and WOMAC at 3 and 6 months. The
significant improvement of patellar position and tibio-femoral joint space was concordant
with the patient’s reporting of improvement in stiffness and pain. The sustained pain relief
and muscle relaxation enabled the patients to optimize physiotherapy thereby improving
endurance training to include the daily activities of life. We conclude that OA knee pain is
a product of neuromyopathy and that PRF of the sensory and motor nerves appeared to
be a safe, effective, and minimally invasive technique. The reduction of pain and stiffness
improved the knee function and probably reduced the peripheral and central sensitization.
Key words: Osteoarthritis, knee pain, stiffness, knee innervation, femoral nerve supply,
Hilton’s law, peripheral sensitization, pulsed radiofrequency treatment of nerves to knee
joint
A Study on the Nerve Supply of the Knee Joint In Cattle