Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan.
Pain Med. 2011 Apr;12(4):546-51. doi: 10.1111/j.1526-4637.2011.01086.x. Epub 2011 Apr 4.
Although severe knee osteoarthritis with refractory pain is commonly treated surgically, this is often not an option for patients with poor health status or unwillingness to undergo major surgery. We examined the efficacy of radiofrequency application to sensory nerves as a novel alternative treatment for refractory knee pain.
This study was an open-label, nonrandomized, and controlled study. Patients complaining of refractory anteromedial knee pain associated with radiological osteoarthritis (moderate or severe) were included. They were assigned to one of two groups: those receiving radiofrequency thermocoagulation (N = 18) or those receiving nerve block (N = 17), depending on the time period that they were referred to the clinic. Radiofrequency current or local anesthetics was applied to the medial retinacular nerve and the infrapatellar branch of the saphenous nerve. Western Ontario McMaster Universities osteoarthritis index score, pain visual analog scale (VAS), and patient's global assessment were assessed with a minimum follow-up of 6 months.
Radiofrequency treatment significantly decreased knee pain as measured by VAS for 12 weeks compared with the control group. In terms of responders, more patients in the RF group responded to the treatment than in the control group. The differences were statistically significant at 4 weeks, 8 weeks, and 12 weeks in pain VAS. Eight patients (44%) treated with radiofrequency rated excellent or good but only three (18%) in the control group rated good, although the difference was not statistically significant.
Some patients were able to benefit substantially from radiofrequency treatment. Even if its effective period is limited, radiofrequency application is a promising treatment to alleviate refractory anteromedial knee pain with osteoarthritis. Further experience and technical improvements are needed to establish its role in the management of knee osteoarthritis.
尽管严重的膝关节骨关节炎伴难治性疼痛通常需要手术治疗，但对于健康状况不佳或不愿接受大手术的患者，这通常不是一种选择。我们研究了射频应用于感觉神经作为治疗难治性膝关节疼痛的一种新的替代方法的疗效。
这是一项开放性、非随机、对照研究。纳入抱怨与放射学骨关节炎（中度或重度）相关的难治性前内侧膝关节疼痛的患者。根据他们就诊的时间，他们被分配到射频热凝（N=18）或神经阻滞（N=17）组之一。将射频电流或局部麻醉剂应用于内侧支持带神经和隐神经髌下支。采用西安大略和麦克马斯特大学骨关节炎指数评分（WOMAC）、疼痛视觉模拟量表（VAS）和患者总体评估，至少随访 6 个月。
与对照组相比，射频治疗在 12 周时 VAS 测量的膝关节疼痛显著降低。在应答者方面，RF 组有更多的患者对治疗有反应，比对照组多。在 4 周、8 周和 12 周时，VAS 的疼痛差异有统计学意义。8 名（44%）接受射频治疗的患者评为优或良，但对照组仅 3 名（18%）评为良，尽管差异无统计学意义。
一些患者可以从射频治疗中获益。即使其有效时间有限，射频应用也是缓解伴骨关节炎的难治性前内侧膝关节疼痛的一种有前途的治疗方法。需要进一步的经验和技术改进来确立其在膝骨关节炎管理中的作用。
