Almeida Matheus, Saragiotto Bruno T, Hunter David J, Dorio Murillo, Duong Vicky, Dutta Rajib, Deveza Leticia
Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil.
Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, NSW, Australia; Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, Brazil.
Osteoarthritis Cartilage. 2025 May;33(5):535-547. doi: 10.1016/j.joca.2025.02.780. Epub 2025 Mar 5.
Osteoarthritis (OA) is a prevalent and disabling joint disorder. Minimally invasive interventions targeting the genicular nerves are widely used for the clinical management of knee OA, but evidence on their efficacy and safety remains uncertain.
To assess the efficacy and safety of minimally invasive interventions targeting the genicular nerves in knee OA.
We searched MEDLINE, Embase, CENTRAL and clinical trial registries, from inception to August 2024.
We included randomised controlled trials evaluating minimally invasive interventions targeting the genicular nerves in patients with knee OA. Comparators included sham/placebo (main comparison), intra-articular injections, and usual care.
Data were extracted independently by two reviewers following the PRISMA guidelines. Risk of bias was assessed using the Cochrane RoB-2 tool, and evidence certainty was evaluated according to the GRADE approach. A random-effects meta-analysis was conducted.
MAIN OUTCOME(S) AND MEASURES(S): The primary outcomes were pain intensity, physical function, and serious adverse events. Secondary outcomes included quality of life and patient-reported global perceived effect.
Twenty-five trials were included (n= 2049) evaluating radiofrequency ablation (RFA), genicular nerve block (GNB) and cryoneurolysis. The certainty of evidence was consistently low to very low across all comparisons. RFA may provide moderate short-term pain relief (0 - 10 scale) compared to sham at 4 weeks (MD -1.70, 95% CI -3.03 to -0.36) and 12 weeks (MD -1.86, 95% CI -2.82 to -0.89), but there was no benefit at 24 and 48 weeks, and no improvements in function at any time point. The evidence is very uncertain for GNB, with only a single trial suggesting small pain reduction and moderate functional improvements at 4 weeks. For cryoneurolysis, very low certainty evidence suggests minimal short-term effects on pain and function. No differences in serious adverse events were observed between minimally invasive interventions and sham/placebo.
The evidence supporting the use of RFA for the management of knee OA is highly uncertain, with modest, short-term benefits that are not sustained. Given the very low certainty of current data, we advise against its routine use until more robust evidence is available.
PROSPERO - CRD42023454756.
骨关节炎（OA）是一种常见且使人致残的关节疾病。针对膝状神经的微创干预措施被广泛用于膝关节OA的临床管理，但关于其疗效和安全性的证据仍不明确。
评估针对膝关节OA的膝状神经微创干预措施的疗效和安全性。
我们检索了MEDLINE、Embase、CENTRAL和临床试验注册库，检索时间从建库至2024年8月。
我们纳入了评估针对膝关节OA患者的膝状神经微创干预措施的随机对照试验。对照包括假手术/安慰剂（主要对照）、关节内注射和常规护理。
两名评审员按照PRISMA指南独立提取数据。使用Cochrane RoB-2工具评估偏倚风险，并根据GRADE方法评估证据确定性。进行随机效应荟萃分析。
主要结局为疼痛强度、身体功能和严重不良事件。次要结局包括生活质量和患者报告的总体感知效果。
纳入了25项试验（n = 2049），评估了射频消融（RFA）、膝状神经阻滞（GNB）和冷冻神经lysis。在所有比较中，证据确定性始终为低至极低。与假手术相比，RFA在4周（MD -1.70，95% CI -3.03至-0.36）和12周（MD -1.86，95% CI -2.82至-0.89）时可能提供中度短期疼痛缓解（0 - 10分制），但在24周和48周时无益处，且在任何时间点功能均无改善。对于GNB，证据非常不确定，仅有一项试验表明在4周时疼痛略有减轻且功能有中度改善。对于冷冻神经lysis，极低确定性证据表明对疼痛和功能的短期影响极小。在微创干预措施与假手术/安慰剂之间未观察到严重不良事件的差异。
支持使用RFA治疗膝关节OA的证据高度不确定，仅有适度的短期益处且未持续。鉴于当前数据的确定性极低，在获得更有力的证据之前，我们建议不要常规使用。
PROSPERO - CRD42023454756 。
