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Musculoskeletal and Sports Medicine

(Research Hub Theater) Patient Factors Affecting Knee Geniculate Nerve Localization Using Ultrasound

Thursday, November 16, 2023
12:45 PM – 2:15 PM CT

    Primary Author(s)

  • Quinn L. Howard, MD (she/her/hers)

    Resident Physician
    University of California (Davis) Health PM&R Program
    Sacramento, California

    • Co-Author(s)

  • WL

    Whitney Liehr, DO

    Resident Physician
    University of California (Davis) Health PM&R Program
    Sacramento, California

  • AW

    Alexandra Warrick, MD

    Assistant Professor
    University of California (Davis) Health System Sports Medicine Fellowship
    Sacramento, California

  • Daniel C. Herman, MD PhD

    Associate Professor
    University of Florida Dept of Orthopedics and Rehabilitation
    Sacramento, California

Background and/or Objectives: Knee geniculate nerve radiofrequency ablation can be performed using ultrasound; however, the factors which influence nerve identification are unknown. The objective of this study was to characterize patient factors affecting localization of the geniculate nerves using ultrasound.

Design: Cross-sectional study

Setting: Outpatient clinic

Participants: 72 subjects with knee osteoarthritis (n=103 knees; male n=37, age=73.3±10.6years, BMI=29.8±7.4kg/m2; female n=66, age=66.8±9.8 years, BMI=32.9±11.4 kg/m2.

Interventions: Ultrasound (X-Porte, FUJIFILM SonoSite Inc., USA) evaluations of the superior lateral (SLN), superior medial (SMN), and inferior medial (IMN) geniculate nerves and their corresponding arteries with and without color flow mode. Chi squared and logistic regression analyses (alpha=0.05) were performed to determine the patient characteristics (age, sex, BMI) associated with visualization.

Main Outcome Measures: Visualization rate

Results: Visualization of the geniculate nerves (SLN=100%, SMN=97.1%, IMN=100%) and corresponding arteries (SLN=95.2%, SMN=92.2%, IMN=98.1%) was high using the standard 2D mode. The artery was visualized using color flow in a greater proportion of male subjects for the SLN (M=64.9%, F=40.9%, p=0.020) and SMN (M=64.9%, F=40.9%, p=0.020), but not the IMN (M=81.1%, F=75.8%, p=0.455). The artery was visualized using color flow in a greater proportion of low ( < 25) versus high (>35) BMI subjects for the SLN (L=78.6%, H=23.2%, p=0.015) and IMN (L=89.3%, H=50.0%, p=0.019), but not the SMN (L=75%, H=26.9%, p=0.089). Age did not affect visualization. Logistic regression identified BMI and sex as independent factors for artery visualization using color flow for the SLN and SMN, and sex for the IMN. These models explained SLN=31.5%, SMN=18.4%, and IMN=18.9% of the variance in artery visualization using color flow.

Conclusions: Localization of the knee geniculate nerves using visualization of the nerves directly and via their corresponding arteries, using a standard 2D ultrasound mode, is high. The utility of color flow mode for this purpose is questionable, particularly for female and high BMI patients.