A Different Approach to the Management of Osteoarthritis in the Knee: Ultrasound Guided Genicular Nerve Block

Dear Editor, A 61-year-old female was referred to our tertiary physical medicine and rehabilitation outpatient clinic with a 7-year history of severe left knee pain. The patient was a nonsmoker and obese, with no comorbidities, and reported that the left knee pain worsened when walking and descending stairs and particularly when climbing stairs. Radiography of the left knee revealed Kellgren-Lawrence grade 3 osteoarthritis (OA) with multiple osteophytes and definite joint space narrowing. The pain and functional disability were nonresponsive to conservative treatment methods including weight loss, exercise, analgesics (paracetamol or diclofenac sodium once or twice a day), intra-articular steroid and hyaluronic acid injections, and physical therapy. The patient was finally offered knee replacement surgery by an orthopedic surgeon, but she did not accept surgery. The sensory and motor nerves supplying all the structures around the knee are the saphenous, tibial, and common peroneal nerves together with the subsartorial, peripatellar, and popliteal plexuses [1,2]. Vas et al. [2] targeted both the sensory and motor nerves supplying all the structures around the knee and succeeded in relieving the pain. Choi et al. [3] reported successful pain relief by ablation of the three branches of the genicular nerve [superior lateral (SL), superior medial (SM), and inferior medial (IM) genicular nerves]. These three nerves were selected because they pass the periosteal areas connecting the shaft of the femur to the bilateral epicondyles and the shaft of …