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Background: Chronic knee pain in older adults is a prevalent condition that significantly impacts quality of life. Transcranial Direct Current Stimulation (tDCS) has emerged as a potential non-invasive treatment option. This scoping review aims to evaluate the efficacy of tDCS in treating chronic knee pain among older adults. Methods: A comprehensive search of peer-reviewed articles was conducted, focusing on randomized controlled trials and pilot studies. Studies were included if they met specific Population, Concept, and Context (PCC) criteria. The primary outcomes assessed were pain reduction and functional improvement. Results: Eleven studies met the inclusion criteria, with a total of 779 participants. However, the results varied across studies, with some showing minimal differences between active tDCS and sham treatments. Advanced neuroimaging techniques, such as functional near-infrared spectroscopy (fNIRS), provided insights into the neuromodulatory effects of tDCS, revealing changes in brain activity related to pain perception. Conclusions: Transcranial Direct Current Stimulation (tDCS) presents a promising avenue for treating chronic knee pain in elderly individuals. However, the current body of research offers mixed results, emphasizing the need for more extensive and standardized studies. Future research should focus on understanding the underlying mechanisms, optimizing treatment protocols, and exploring the long-term effects and safety of tDCS. [ABSTRACT FROM AUTHOR]

Increased physical activity is an effective treatment for knee osteoarthritis that causes knee pain. However, due to the coronavirus disease 2019, noncontact and non-face-to-face interventions have increased, but the quality of evidence supporting their effectiveness remains unclear. The purpose of the study was to assess the quality of evidence of the effects of non-face-to-face and noncontact interventions on knee pain and physical activity in older adults with knee osteoarthritis. A meta-analysis was conducted to determine the effects of different intervention methods (education and exercise). The Cochrane Central Register of Controlled Trials, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Physiotherapy Evidence Database were systematically searched. Four randomized controlled trials were included in the analysis. The meta-analysis demonstrated that the educational intervention group was significantly effective, although supportive evidence was low quality. Educational intervention may be effective, but the effects need to be confirmed by higher quality clinical trials. [ABSTRACT FROM AUTHOR]

Background and Aims: Five to ten percent of people having a knee arthroplasty for osteoarthritis continue to experience high pain levels more than 3 months after surgery. The primary aim of this study was to determine the relative risk (RR) of having high pain at 12 and 36 months based on the presence of high pain at 3 and 12 months, respectively. Methods: A retrospective analysis of data from a prospective study of participants who had a total knee arthroplasty for osteoarthritis. A score of ≤14 on the Oxford Knee Pain Subscale was defined as 'High Pain', and RRs were calculated comparing those with high or low pain. Results: There were 718 participants and 13.8% reported high pain at any time point, 2.5% reported high pain at all time points and 10.3% and 4.7% and 6.6% reported high pain at 3‐, 12‐ and 36‐months, respectively, post‐surgery. For participants with high pain at 3 months, 33.8% had high pain at 12 months with a RR of 24.2 (95% CI 11.7–49.8, p < 0.001) and 35.1% had high pain at 36 months with a RR of 10.8 (95% CI 6.4–18.2, p < 0.001). For participants with high pain at 12 months, 67.6% had high pain at 36 months, with a RR of 19.3 (95% CI 12.2–30.4, p < 0.01). Conclusions: Although high pain rates are low overall following knee arthroplasty, once high pain is established there is an elevated RR of it persisting at 12‐ and 36 months post‐surgery. Trial registration: The data were collected in the Evidence‐based Processes and Outcomes of Care (EPOC) study, ClinicalTrials.gov Identifier: NCT01899443. [ABSTRACT FROM AUTHOR]

Background: Chronic knee pain in older adults is a prevalent condition that significantly impacts quality of life. Transcranial Direct Current Stimulation (tDCS) has emerged as a potential non-invasive treatment option. This scoping review aims to evaluate the efficacy of tDCS in treating chronic knee pain among older adults. Methods: A comprehensive search of peer-reviewed articles was conducted, focusing on randomized controlled trials and pilot studies. Studies were included if they met specific Population, Concept, and Context (PCC) criteria. The primary outcomes assessed were pain reduction and functional improvement. Results: Eleven studies met the inclusion criteria, with a total of 779 participants. However, the results varied across studies, with some showing minimal differences between active tDCS and sham treatments. Advanced neuroimaging techniques, such as functional near-infrared spectroscopy (fNIRS), provided insights into the neuromodulatory effects of tDCS, revealing changes in brain activity related to pain perception. Conclusions: Transcranial Direct Current Stimulation (tDCS) presents a promising avenue for treating chronic knee pain in elderly individuals. However, the current body of research offers mixed results, emphasizing the need for more extensive and standardized studies. Future research should focus on understanding the underlying mechanisms, optimizing treatment protocols, and exploring the long-term effects and safety of tDCS.

BACKGROUND: Monopolar radiofrequency ablation (MRFA) of the genicular nerves has been considered the main interventional treatment for chronic knee pain. However, the variable locations of these nerves could suggest that traditional MRFA of genicular nerves may be insufficient to cover the area needed to provide complete sensory denervation. For these reasons, some alternatives have been proposed to achieve an increase in the lesion area that offers better outcomes such a bipolar radiofrequency ablation (BRFA). OBJECTIVE: To describe the efficacy and safety of the bipolar radiofrequency ablation (BRFA) of the genicular nerves in the patients with chronic knee pain. METHODS: A retrospective study was conducted in the Pain Medicine Department. Institutional review board approval from the Hospital Ethical Committee and informed consent were obtained. We reviewed our database for BRFA of genicular nerves from January 2018 to December 2021 for patients with chronic knee pain. The cannulas were placed using ultrasound guidance (10 cm, 22-gauge and 10 mm active curved tip), and each pair of cannulas were subjected to BRFA for 90 seconds at 80 ∘ C. Data analysis was conducted using T-test for paired variables (Visual analogue scale and EuroQol, an instrument intended to complement other forms of quality-of-life measures). RESULTS: Twenty-five patients met inclusion criteria after excluding 7 based on the study design. The mean improvement of our patients according to the VAS was - 3.98 (95%CI: - 4.37 to - 3.59) p < 0.0001 and EuroQol + 0.416 (95%CI: 0.364 to 0.468) p < 0.0001. The mean duration of improvement was 8 (6–11) months after BRFA. There were no reported serious adverse events related to the procedure, only local pain for 24 to 48 hours in 3 patients. CONCLUSIONS: We can conclude that BRFA reduces procedural pain and increases the treatment area, providing more complete sensory denervation and improved clinical outcomes. [ABSTRACT FROM AUTHOR]

Background and objectives: Some patients with chronic knee pain experience an increase in knee pain following a single bout of exercise involving their knee joint, which can negatively affect exercise adherence and thus result in reduced overall health and lack of disease management. We want to determine whether a single bout of upper-body (UB) aerobic arm-ergometry exercise is effective in reducing the experience of pain in those with chronic knee pain compared with lower-body (LB) aerobic leg ergometry exercise. Methods: A total of 19 individuals (women = 11, men = 8; age = 63 ± 8 years; body mass index = 24 ± 3 kg/m²) who suffered from chronic knee pain for =3 months took part in this study. Arm-ergometry and cycle-ergometry exercises were performed for 30 min at a moderate intensity, separated by 7 days. Pain intensity was assessed by means of a visual analogue scale (VAS) pre- and post-exercise and for 7 days post-exercise. Pressure pain threshold (PPT) and mechanical detection threshold (MDT) were measured pre- and post-exercise at both local and distal anatomical sites. Data are presented as mean ± SD. Results: VAS pain was significantly reduced (p = 0.035) at 1 day post-exercise following the UB exercise trial (-1.4 ± 0.8) when compared with the LB exercise trial (+0.1 ± 2.1). Both UB and LB exercises were effective in reducing local and distal PPT. MDT responses were heterogeneous, and no differences between the UB and LB exercise conditions were noted. Conclusion: An acute bout of upper-body aerobic arm-ergometry exercise evoked a significant decrease in the affected knee joint pain in individuals with chronic knee pain of up to 24 h/1 day post-exercise compared with lower-body aerobic exercise. While the exact mechanisms remain unclear, upper-body exercise may offer a viable, novel therapeutic treatment for patients with chronic knee pain. [ABSTRACT FROM AUTHOR]

Background and objectivesSome patients with chronic knee pain experience an increase in knee pain following a single bout of exercise involving their knee joint, which can negatively affect exercise adherence and thus result in reduced overall health and lack of disease management. We want to determine whether a single bout of upper-body (UB) aerobic arm-ergometry exercise is effective in reducing the experience of pain in those with chronic knee pain compared with lower-body (LB) aerobic leg ergometry exercise.MethodsA total of 19 individuals (women = 11, men = 8; age = 63 ± 8 years; body mass index = 24 ± 3 kg/m2) who suffered from chronic knee pain for ≥3 months took part in this study. Arm-ergometry and cycle-ergometry exercises were performed for 30 min at a moderate intensity, separated by 7 days. Pain intensity was assessed by means of a visual analogue scale (VAS) pre- and post-exercise and for 7 days post-exercise. Pressure pain threshold (PPT) and mechanical detection threshold (MDT) were measured pre- and post-exercise at both local and distal anatomical sites. Data are presented as mean ± SD.ResultsVAS pain was significantly reduced (p = 0.035) at 1 day post-exercise following the UB exercise trial (−1.4 ± 0.8) when compared with the LB exercise trial (+0.1 ± 2.1). Both UB and LB exercises were effective in reducing local and distal PPT. MDT responses were heterogeneous, and no differences between the UB and LB exercise conditions were noted.ConclusionAn acute bout of upper-body aerobic arm-ergometry exercise evoked a significant decrease in the affected knee joint pain in individuals with chronic knee pain of up to 24 h/1 day post-exercise compared with lower-body aerobic exercise. While the exact mechanisms remain unclear, upper-body exercise may offer a viable, novel therapeutic treatment for patients with chronic knee pain.

Lipomas are the most common benign soft tissue tumors, occurring in almost any part of the body and prevalent in 2% of the population. The occurrence of intra-articular lipoma is rare and mostly documented in the anterior compartment of the knee joint, like the Hoffman pad of fat and suprapatellar region. The incidence of intra-articular lipoma in the posterior compartment of the knee joint is very rare. Herein, the authors presented a case report of a 21-year-old female with a history of chronic intermittent left knee joint pain for the last two years. Magnetic Resonance Imaging (MRI) revealed a well-defined, encapsulated lesion that was hyperintense on T1/ T2 images and hypointense on, located in the intercondylar notch, anterior to the proximal half of the posterior cruciate ligament, and closely abutting the ligament. Computed Tomography (CT) showed a fat density lesion (-82 to -93 HU), indicating a lipomatous lesion. The patient underwent laparoscopic removal of this lesion, and histopathology confirmed the fatty nature of the lesion.

Background: Osteoarthritis (OA) of the knee is the most frequent progressive degenerative joint disease with a 20% prevalence in India. Many patients with knee OA elect to avoid surgery, and others are poor surgical candidates due to medical comorbidities. Aims: This study aimed to determine 3-, 6-, and 12-month clinical outcomes of genicular nerve cooled radiofrequency ablation (CRFA) for the treatment of chronic pain due to primary knee OA. Study Settings and Design: The present study, a single-armed prospective observational study, was conducted in a tertiary care hospital between March 2020 and December 2021. The genicular nerve CRFA treatments were performed in chronic knee OA patients with a radiological grade of 2 (mild), 3 (moderate), or 4 (severe) (Kellgren and Lawrence system) not responding to conservative therapies for at least 6 months. A total of 70 patients were enrolled in the study. Out of this, 62 patients were finally analyzed for the study. Methods: All the patients received procedural sedation and were placed in the supine position on the operating table. Fluoroscopy-guided CRF genicular nerve ablation was performed using anatomic landmarks at superior lateral, superior medial, and inferior medial sites. Further needle position was confirmed by motor and sensory stimulation. Each target was sequentially lesioned for 2 min and 30 s at a set temperature of 60°C. The average procedure duration was 40 min for the index knee. The patient was discharged on the same day. All patients were followed up in person after 3, 6, and 12 months. Patients answered the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire (96 points) and Numeric Rating Scale (NRS) pain score (0 – no pain and 10 – maximum pain) before the procedure and during each follow-up after treatment. Statistical Analysis: Results were analyzed using Pearson's Chi-square test, Fisher's exact test, and ANOVA as appropriate. P >0.05 was considered statistically significant. Results: The average mean baseline pain score was 9.00 (8.41 ± 0.66) and the mean WOMAC score was 80.00 (80.02 ± 6.92). The pain score (NRS) and WOMAC score at 3-, 6-, and 12-month intervals after postprocedure follow-up were reduced significantly from the baseline level (P < 0.001). Total 91.93% (57/62) of the patients successfully responded (≥50% improvement from the baseline was a good response) to the treatment according to NRS pain score during 3- and 6-month follow-up visits. Then, it was reduced to 77.41% (48/62) during 12 months of follow-up visits. Similarly, the average median WOMAC score was reduced to 25.00 (28.80 ± 10.82), 25.00 (29.35 ± 11.12), and 34.00 (34.96 ± 11.28) during a subsequent follow-up visit at 3, 6, and 12 months. Hence, the response to the cooled radiofrequency treatment was good (≥50% improvement) throughout the study period of 12 months according to the NRS pain score and the global subjective improvement score (WOMAC score). There were a few 11 (17.74%) minor complications, e.g. mild swelling and pain were reported in the immediate postprocedure period. Moreover, only 4 (6.45%) patients had late complication as hypoesthesia over shin bone in our study. Conclusions: CRFA of the genicular nerve in chronic knee OA provides long-term pain relief and improved function for at least a 12-month duration without any significant complications.

Introduction: The International Knee Documentation Committee−Subjective Form (IKDC-SF) is one of the most used measures for evaluating the quality of life among people experiencing knee pain but is not yet available in Hebrew. Similarly, the Tampa Scale for Kinesiophobia (TSK), used to evaluate fear of movement, is not available in Hebrew. This study aimed to determine the reliability and construct validity of the Hebrew IKDC-SF and TSK among people experiencing chronic knee pain. Materials and methods: Translation and cultural adaptation of the IKDC-SF and TSK questionnaires, followed by test–retest reliability within a two-week interval. We report on internal consistency, construct validity, and the psychometric properties of both questionnaires. Results: Both questionnaires showed high internal consistency (Cronbach's α = 0.85 and 0.89, respectively) and test–retest reliability, expressed by the Intra-Class Correlation Coefficient (ICC = 0.89 and 0.80 respectively). The standard error of measurement, group smallest real difference and minimal detectable change for the IKDC-SF were 4.66, 9.13, and 12.91 points, and 3.64, 7.13, and 10.08 points for the TSK, respectively. Conclusion: We demonstrated that the Hebrew version of the IKDC-SF and TSK is reliable and valid for assessing QoL, function, and kinesiophobia among people experiencing chronic knee pain. [ABSTRACT FROM AUTHOR]

Abstract Background Moderate to severe levels of persistent knee pain have been estimated to affect up to 25% of people 3-months or more after a total knee replacement. It is unknown whether the type of rehabilitation pathway is associated with persistent high pain after surgery. Using a prospectively followed Australian cohort who underwent total knee replacement for knee osteoarthritis, this study aimed to i) report the incidence of high-intensity knee pain (defined as a score ≤ 15 on the Oxford Knee Score pain subscale) across time and ii) identify whether referral to inpatient rehabilitation was one of the predictors of persistent pain at 3-months post-surgery. Methods A retrospective analysis of a large prospective study was conducted using the Oxford Knee Score pain subscale to determine if participants had high pain at 3-months, 12-months and 36-months post-surgery. Relative risks for high pain at 3-, 12- and 36-months between the type of rehabilitation pathway were determined using Poisson multivariable regression with robust standard errors. The same technique was also employed to determine potential predictors, including rehabilitation pathway, of high pain at 3 months. Results The incidence of high pain in all participants was 73% pre-surgery and 10, 5 and 6% at 3-, 12- and 36-months respectively following knee replacement. There was a significant interaction between time and rehabilitation pathway, suggesting that the effect of the rehabilitation pathway varied across time. The incidence of high pain at 3-months did not significantly differ between those who attended inpatient rehabilitation (11.6%) and those discharged directly home (9.5%). Multivariable Poisson regression analysis identified the pre-surgical presence of high pain, co-morbid low back pain or other lower limb problem, younger age and having a major complication within 3-months following surgery as significant predictors of persistent pain whilst discharge to inpatient rehabilitation was not. Conclusion A small but clinically significant minority of people continued to have high pain levels at 3-, 12- and 36-months following a primary total knee replacement for osteoarthritis. Participation in an inpatient rehabilitation program does not appear to be an important predictor of ongoing knee pain. Trial registration The data were collected in the Evidence-based Processes and Outcomes of Care (EPOC) study, ClinicalTrials.gov Identifier: NCT01899443

Leonardo Kapural,1 Amela Minerali,1 Matthew Sanders,2 Matejic Matea,1 Simran Dua1 1Carolinas Pain Institute, Winston Salem, NC, USA; 2Pain Management Fellowship Program, Department of Anesthesiology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USACorrespondence: Leonardo Kapural, Carolinas Pain Institute, Tel +1 336 714-8381, Fax +1 336 765-8492, Email lkapuralmd@gmail.comBackground: Genicular radiofrequency ablation is an established therapy for chronic knee pain. An analysis comparing different probe sizes and technologies has not yet been undertaken for this indication. This large retrospective, comparison study from a single-center comprehensive pain management practice aims to do that.Methods: Outcomes of 170 patients who underwent traditional radiofrequency ablation (tRFA) for chronic knee pain were compared to 170 consecutive patients who received cooled radiofrequency ablation (CRFA) with similar (p=0.5) pre-procedural pain scores.Results: The VAS pain score at the first post-procedure visit at 4– 6 weeks decreased to 5.07± 2.8 cm for tRFA and to 4.26 ± 3.2 cm for CRFA (p< 0.001 for both from baseline). The difference was profound and significantly better in the favor of CRFA (p< 0.001) as the duration of reduction of pain scores by greater than 50% was 2.6 months for tRFA and 11.1 months for CRFA. There were only 15 patients (8.8%) who continued to receive > 50% of pain relief in tRFA at 12 months, as opposed to 78 (46%) at 12 months for CRFA. We compared the initial outcomes and long-term pain relief. Long-term outcomes were better for the bigger lesion size treatment group patients.Conclusion: We conclude that the duration and intensity of pain relief were of a greater magnitude after the larger diameter probe cooled RFA.Keywords: radiofrequency ablation, chronic knee pain, knee osteoarthritis, pain management

Objectives: Effective brief instructions for self-management of chronic knee pain are needed. Methods: Forty-six participants with chronic knee pain were randomly allocated into two programmes: material-based education alone or brief self-exercise education (brief-See), which comprised a 100-minute instruction for self-exercise combined with compact pain education. Total function (KOOS4, 4-subscale average of knee injury and osteoarthritis outcome score), pain intensity (NRS, numeric rating scale), self-efficacy (PSEQ, pain self-efficacy questionnaire), and health-related quality of life (EQ-5D, European quality of life-5 dimensions) were evaluated at baseline and 4 and 12 weeks after the initial intervention. A generalized mixed linear model estimated average group differences in changes from baseline and 95% confidence intervals (95% CIs) using intention-to-treat principle. Results: Compared to material-based education alone, the brief-See provided significant additional improvements of 9.4% (95% CI: 2.3 to 16.4) on the KOOS4 and 5.4 points (0.3 to 10.4) on the PSEQ at 12 weeks but did not on the NRS and EQ-5D. Adherence and satisfaction were favourable in the brief-See without any notable adverse event. Conclusions: Adding the brief-See to material-based education could be more acceptable and restore total function and self-efficacy, which could contribute to the self-management of chronic knee pain in primary care. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis (OA) of the knee is the most frequent progressive degenerative joint disease with a 20% prevalence in India. Many patients with knee OA elect to avoid surgery, and others are poor surgical candidates due to medical comorbidities. Aims: This study aimed to determine 3-, 6-, and 12-month clinical outcomes of genicular nerve cooled radiofrequency ablation (CRFA) for the treatment of chronic pain due to primary knee OA. Study Settings and Design: The present study, a single-armed prospective observational study, was conducted in a tertiary care hospital between March 2020 and December 2021. The genicular nerve CRFA treatments were performed in chronic knee OA patients with a radiological grade of 2 (mild), 3 (moderate), or 4 (severe) (Kellgren and Lawrence system) not responding to conservative therapies for at least 6 months. A total of 70 patients were enrolled in the study. Out of this, 62 patients were finally analyzed for the study. Methods: All the patients received procedural sedation and were placed in the supine position on the operating table. Fluoroscopy-guided CRF genicular nerve ablation was performed using anatomic landmarks at superior lateral, superior medial, and inferior medial sites. Further needle position was confirmed by motor and sensory stimulation. Each target was sequentially lesioned for 2 min and 30 s at a set temperature of 60°C. The average procedure duration was 40 min for the index knee. The patient was discharged on the same day. All patients were followed up in person after 3, 6, and 12 months. Patients answered the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire (96 points) and Numeric Rating Scale (NRS) pain score (0 -- no pain and 10 -- maximum pain) before the procedure and during each follow-up after treatment. Statistical Analysis: Results were analyzed using Pearson's Chi-square test, Fisher's exact test, and ANOVA as appropriate. P >0.05 was considered statistically significant. Results: The average mean baseline pain score was 9.00 (8.41 ± 0.66) and the mean WOMAC score was 80.00 (80.02 ± 6.92). The pain score (NRS) and WOMAC score at 3-, 6-, and 12-month intervals after postprocedure follow-up were reduced significantly from the baseline level (P < 0.001). Total 91.93% (57/62) of the patients successfully responded (≥50% improvement from the baseline was a good response) to the treatment according to NRS pain score during 3- and 6-month follow-up visits. Then, it was reduced to 77.41% (48/62) during 12 months of follow-up visits. Similarly, the average median WOMAC score was reduced to 25.00 (28.80 ± 10.82), 25.00 (29.35 ± 11.12), and 34.00 (34.96 ± 11.28) during a subsequent follow-up visit at 3, 6, and 12 months. Hence, the response to the cooled radiofrequency treatment was good (≥50% improvement) throughout the study period of 12 months according to the NRS pain score and the global subjective improvement score (WOMAC score). There were a few 11 (17.74%) minor complications, e.g. mild swelling and pain were reported in the immediate postprocedure period. Moreover, only 4 (6.45%) patients had late complication as hypoesthesia over shin bone in our study. Conclusions: CRFA of the genicular nerve in chronic knee OA provides long-term pain relief and improved function for at least a 12-month duration without any significant complications. [ABSTRACT FROM AUTHOR]

Introduction: Chronic knee pain is defined as pain that persists or recurs over 3 months. The most common is degenerative osteoarthritis (OA). This review represents a comprehensive description of the pathology, diagnosis, and treatment of OA of the knee., Methods: The literature on the diagnosis and treatment of chronic knee pain was retrieved and summarized. A modified Delphi approach was used to formulate recommendations on interventional treatments., Results: Patients with knee OA commonly present with insidious, chronic knee pain that gradually worsens. Pain caused by knee OA is predominantly nociceptive pain, with occasional nociplastic and infrequent neuropathic characteristics occurring in a diseased knee. A standard musculoskeletal and neurological examination is required for the diagnosis of knee OA. Although typical clinical OA findings are sufficient for diagnosis, medical imaging may be performed to improve specificity. The differential diagnosis should exclude other causes of knee pain including bone and joint disorders such as rheumatoid arthritis, spondylo- and other arthropathies, and infections. When conservative treatment fails, intra-articular injections of corticosteroids and radiofrequency (conventional and cooled) of the genicular nerves have been shown to be effective. Hyaluronic acid infiltrations are conditionally recommended. Platelet-rich plasma infiltrations, chemical ablation of genicular nerves, and neurostimulation have, at the moment, not enough evidence and can be considered in a study setting. The decision to perform joint-preserving and joint-replacement options should be made multidisciplinary., Conclusions: When conservative measures fail to provide satisfactory pain relief, a multidisciplinary approach is recommended including psychological therapy, integrative treatments, and procedural options such as intra-articular injections, radiofrequency ablation, and surgery., (© 2024 The Author(s). Pain Practice published by Wiley Periodicals LLC on behalf of World Institute of Pain.)

Chronic knee pain from osteoarthritis (OA) is a leading cause of disability, with limited treatment options for patients who fail conservative management and intra-articular (IA) injections. Genicular nerve blocks (GNBs) have emerged as a promising treatment for chronic knee pain, especially in patients who are not candidates for total knee replacement (TKR). This case series discusses six patients with chronic knee pain from OA who failed conventional treatments, including IA injections, and found significant relief with GNBs.

Background: Chronic knee pain represents a major cause of disability and a burden on healthcare systems worldwide, being more prevalent in middle-aged and elderly patients. It can take a toll on patients' daily life, keeps them from their favorite activities, saps of productivity, and diminishes overall quality of life. It can be caused by degenerative conditions, such as osteoarthritis (the most common cause), rheumatoid arthritis, crystalline arthritis and gout. lifestyle modification, pharmacologic management, and injections are the mainstay of therapy for elderly patients having chronic symptomatic knee pain with multiple medical comorbidities who do not wish/fit for surgical options. Intra-articular corticosteroid injection (IACSI) was commonly adopted to alleviate chronic knee pain and was traditionally performed blindly depending only on anatomical land marks. Recently, Genicular nerve block (GNB) has recently emerged as a novel alternative treatment for chronic knee pain. Both Intra-articular corticosteroid injection (IACSI) and Genicular nerve block (GNB) can be carried out under Ultrasound guidance as a safer, cheaper and more feasible imaging modality for guidance as it provides real-time imaging for the knee structures in a dynamic manner giving the ability to do interventional procedures and providing more effective clinical results when compared to blind injections. Aim of the Work: Illustrate the technical aspects, the indications and the methodology of local therapies for chronic knee pain performed by interventional radiologists and provide current evidence. Assess the efficacy of Ultrasound (US) guided intraarticular corticosteroids injection and Genicular nerve block to control moderate and advanced chronic knee pain. Compare the immediate and short-term symptomatic and functional improvement obtained after both techniques. Patients and Methods: The study was carried out on 30 patients of symptomatic chronic knee pain with radiologically proven knee joint arthritis (26 of them had osteoarthritis, 3 had gout arthritis and one patient had rheumatoid arthritis), all of them were not responding to medical treatment. They were divided into two groups (intraarticular corticosteroids injection group and Genicular nerve block one) both procedures were performed under ultrasound guidance to identify target points for injection. GNB target points for injection where close to the superior lateral, superior medial and inferior medial genicular arteries while target point for the IACSI group was the suprapatellar bursa. All procedures were performed with a spinal needle (22 G) introduced under ultrasound guidance till reaching the desired target points at both groups. Then injection of a mixture of Lidocaine, Bupivacaine hydrochloride and Triamcinolone Acetonide was done. Results: In our study, in IACSI group the mean of initial VAS was 80.7±10.3 compared to 81.3±7.7 in GNB group. The mean VAS significantly dropped to be 20.7± 5.3 in IACSI group compared to 18.3±5.9 in GNB group. After 2 weeks, it was 34.3 ± 8.4 and 27.7±8.2 respectively. After 4 weeks, it increased to 40±8.7 and 33.7±9.3 respectively. At 8 weeks, it was obviously increased to 75.3±10.3 and 66.7±11.4 respectively and the effect returned gradually till nearly the baseline at 8 weeks. In our study, in IACSI group the mean of initial OKS was 48.6±7.4 compared to 50.1±7.6 in GNB group. After 2 weeks, it was markedly decreased to 25.5±3.9 and 22.7±6.8 respectively. After 4 weeks, it increased to 31.1±3.5 and 27. ±6.9 respectively. At 8 weeks, it was obviously increased to 44.1±7.1 and 39.3±6.1 respectively and the effect returned gradually till nearly the baseline at 8 weeks. Conclusion: Ultrasound guided genicular nerve block with a mixture of corticosteroid and local anesthetic is an effective, radiation free method to alleviate chronic knee pain and improve knee joint function. US guided intra-articular cortico-steroid injection through suprapatellar approach is also an effective method to relive chronic knee pain and inflammation and to improve knee joint functional capacity. Both procedures are effective in alleviation of chronic knee pain for up to 4 weeks with marked decrease in VAS score after 2 weeks and slight increasing trend towards 4 weeks. The favorable effect returned gradually till nearly the baseline at 8 weeks. Genicular nerve block is more effective than intra-articular corticosteroid injection in both pain alleviation and improving knee joint function. The earlier the Kellgren-Lawrence score is, the more reduction in chronic knee pain and the more improvement of joint function is achieved after both procedures. [ABSTRACT FROM AUTHOR]

Background: Moderate to severe levels of persistent knee pain have been estimated to affect up to 25% of people 3-months or more after a total knee replacement. It is unknown whether the type of rehabilitation pathway is associated with persistent high pain after surgery. Using a prospectively followed Australian cohort who underwent total knee replacement for knee osteoarthritis, this study aimed to i) report the incidence of high-intensity knee pain (defined as a score ≤ 15 on the Oxford Knee Score pain subscale) across time and ii) identify whether referral to inpatient rehabilitation was one of the predictors of persistent pain at 3-months post-surgery.Methods: A retrospective analysis of a large prospective study was conducted using the Oxford Knee Score pain subscale to determine if participants had high pain at 3-months, 12-months and 36-months post-surgery. Relative risks for high pain at 3-, 12- and 36-months between the type of rehabilitation pathway were determined using Poisson multivariable regression with robust standard errors. The same technique was also employed to determine potential predictors, including rehabilitation pathway, of high pain at 3 months.Results: The incidence of high pain in all participants was 73% pre-surgery and 10, 5 and 6% at 3-, 12- and 36-months respectively following knee replacement. There was a significant interaction between time and rehabilitation pathway, suggesting that the effect of the rehabilitation pathway varied across time. The incidence of high pain at 3-months did not significantly differ between those who attended inpatient rehabilitation (11.6%) and those discharged directly home (9.5%). Multivariable Poisson regression analysis identified the pre-surgical presence of high pain, co-morbid low back pain or other lower limb problem, younger age and having a major complication within 3-months following surgery as significant predictors of persistent pain whilst discharge to inpatient rehabilitation was not.Conclusion: A small but clinically significant minority of people continued to have high pain levels at 3-, 12- and 36-months following a primary total knee replacement for osteoarthritis. Participation in an inpatient rehabilitation program does not appear to be an important predictor of ongoing knee pain.Trial Registration: The data were collected in the Evidence-based Processes and Outcomes of Care (EPOC) study, ClinicalTrials.gov Identifier: NCT01899443. [ABSTRACT FROM AUTHOR]

Context: Excessive knee valgus and tibial external rotation relative to the femur during weight bearing motions, such as jump-landing, reportedly increases the risk of developing chronic knee pain, such as patellofemoral pain. Excessive deviations from normal ranges of several static lower extremity alignment measures and dynamic hip motions may also increase the risks for patellofemoral pain. Objective: To determine the relationship between lower extremity alignments and hip motions to frontal and transverse plane knee motions during double-leg landings. Design: Correlational study. Setting: Laboratory. Patients or Other Participants: 69 healthy, competitive athletes (27 men, 42 women; height, 166.5 ± 9.5 cm; weight, 61.3 ± 9.9 kg; age, 20.7 ± 1.0 y) participated in this study. Interventions: Prone and supine hip version, quadriceps angle, and tibiofemoral angle were measured. Frontal and transverse knee and hip angles at peak knee extensor moment during landing were calculated. Main Outcome Measures: 2 separate stepwise multiple regression analyses were conducted to predict frontal and transverse plane knee motions using 4 static lower extremity alignment measures and hip motions. Results: Greater hip adduction and prone hip anteversion, and lesser hip internal rotation and supine hip anteversion, were related to greater knee valgus motions (R2 = .475, P < .01). Greater hip adduction was related to greater knee external rotation (R² = .205, P < .01). Conclusions: Some targeted static lower extremity alignments and hip motions are associated with frontal and transverse knee motions. However, stronger relationships of hip motions with knee motions than static lower extremity alignments provided evidence that improving hip movements may help improve patellofemoral pain in those with lower extremity malalignments. [ABSTRACT FROM AUTHOR]

Introduction: People do health care not only to diagnose and relieve pain but also to reduce pain, anxiety, and loneliness in their daily lives. The present study aims to evaluate the effectiveness of Morita therapy among older women suffering from emotional distress and social isolation with chronic knee pain. Methods: The research method was pretest - posttest with a control group. The statistical population of the study included the older adults with chronic knee pain in the period of May to August 2020 in Tabriz, Iran. The sample consisted of 30 female patients aged 60-70 years with chronic knee pain who entered the study by convenience sampling method and randomly assigned to experimental and control group (15 patients each group). The research instruments included the Depression Anxiety and Stress Scale (DASS-21) and the Lubben Social Network Scale (LSNS). In the experimental group, Morita therapy was held during nine sessions for 90 minutes once a week. Results: The results of multivariate analysis of covariance showed significant effectiveness of Morita therapy on emotional distress and social isolation (p < 0.001). Morita therapy significantly reduced patientschr('39') depression and anxiety scores (Eta = 0.68). In addition, the social isolation scores of the experimental group significantly reduced compared to the control group (p < 0.001), which indicates an increase in the quality of social network (Eta = 0.49). Conclusion: Morita therapy can help reduce emotional distress and social isolation in older women with chronic knee pain and can be used in conjunction with other common therapies.

Objective: To assess long‐term outcomes of cooled radiofrequency ablation (CRFA) of genicular nerves for chronic knee pain due to osteoarthritis (OA). Methods: A prospective, observational extension of a randomized, controlled trial was conducted on adults randomized to CRFA. Subjects were part of a 12‐month clinical trial comparing CRFA of genicular nerves to a single hyaluronic injection for treatment of chronic OA knee pain, who then agreed to visits at 18‐ and 24‐months post CRFA and had not undergone another knee procedure since. The subjects were evaluated for pain using the Numeric Rating Scale (NRS) function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), subjective benefit using the Global Perceived Effect (GPE) scale, quality of life using the EuroQol‐5‐Dimensions‐5 Level (EQ‐5D‐5L) questionnaire, and safety. Results: Of 57 subjects eligible, 36 enrolled; 32 completed the 18‐month visit with a mean NRS score of 2.4 and 22 (69%) reporting ≥50% reduction in pain from baseline (primary endpoint); 27 completed the 24‐month visit, with a mean NRS of 3.4 and 17 (63%) reporting ≥50% pain relief. Functional and quality of life improvements persisted similarly, with mean changes from baseline of 53.5% and 34.9% in WOMAC total scores, and 24.8% and 10.7% in EQ‐5D‐5L Index scores, at 18‐ and 24‐months, respectively. There were no identified safety concerns in this patient cohort. Conclusion: In this subset of subjects, CRFA of genicular nerves provided durable pain relief, improved function, and improved quality of life extending to 24 months post procedure, with no significant safety concerns. [ABSTRACT FROM AUTHOR]

Wet cupping therapy is an economical and simple treatment that still needs scientific interpretation. The main aim of this study is to investigate the impact of wet cupping therapy in reducing and reliving of the degree, signs, and symptoms of knee pain. Methods: Quasi-experimental study design. Data collected from 80 patients diagnosed as suffering from chronic knee pain. The patients were split into two groups, a control and an experimental group. Patients in the experimental group were offered physical therapy modalities (e.g., ice-back, ultrasound and exercise) and wet cupping therapy services. The control group only received physical therapy treatment modalities (i.e., no wet cupping). Patients in the experimental group were prescribed three staged wet cupping therapy monthly. Results: Wet cupping therapy was helpful with clinically significant effectiveness in the experimental group. The results showed that cupping reduced the degree of knee pain, where p-values were (0.000), and the signs and symptoms were reduced; also p-values were (0.000). Conclusions: The wet cupping therapy is an effective method in treating musculoskeletal disorders, especially chronic knee pain, and that much helpful in improving quality of life of patients. [ABSTRACT FROM AUTHOR]

Background: Radiofrequency (RF) treatment of the genicular nerves offers pain relief in patients suffering from chronic knee pain including persistent post‐surgical knee pain (PPSP). We present the first case report of the development of complex regional pain syndrome (CRPS) in a chronic knee pain patient after an RF ablation of the genicular nerves that was successfully treated with dorsal root ganglion (DRG) stimulation. Case Presentation: The patient developed increased pain, sympathetic and dysmorphic changes of the index knee 10 weeks after RF treatment for PPSP. Diagnosis of CRPS type II was made using positive clinical findings and the Budapest diagnostic tool. Laboratory workup and PET‐CT were negative. The patient was refractory to usual care and she was treated successfully with dorsal ganglion root stimulation. Conclusions: Complex regional pain syndrome is a possible complication of RF ablation of the genicular nerves in patients with chronic knee pain, and DRG stimulation may be a treatment option. Physicians should be aware of this complication, especially when patients have a medical history of CRPS. [ABSTRACT FROM AUTHOR]

The objective was to determine the effectiveness of fluoroscopically guided genicular nerve radiofrequency ablation for painful knee osteoarthritis. Primary outcome measure was improvement in pain after 6 mos. Secondary outcomes included the Oxford Knee Score and Western Ontario and McMaster Universities Osteoarthritis Index. Two reviewers independently assessed publications before October 10, 2020. The Cochrane Risk of Bias Tool and Grades of Recommendation, Assessment, Development, and Evaluation system were used. One hundred ninety-nine publications were screened, and nine were included. Six-month success rates for 50% or greater pain relief after radiofrequency ablation ranged from 49% to 74%. When compared with intra-articular steroid injection, the probability of success was 4.5 times higher for radiofrequency ablation (relative risk = 4.58 [95% confidence interval = 2.61–8.04]). When radiofrequency ablation was compared with hyaluronic acid injection, the probability of treatment success was 1.8 times higher (relative risk = 1.88, 95% confidence interval = 1.38–2.57). The group mean Oxford Knee Score and Western Ontario and McMaster Universities Osteoarthritis Index scores improved in participants receiving genicular radiofrequency ablation compared with intra-articular steroid injection and hyaluronic acid injection. According to Grades of Recommendation, Assessment, Development, and Evaluation, there is moderate-quality evidence that fluoroscopically guided genicular radiofrequency ablation is effective for reducing pain associated with knee osteoarthritis at minimum of 6 mos. Further research is likely to have an important impact on the current understanding of the long-term effectiveness of this treatment. [ABSTRACT FROM AUTHOR]

Yasuhiro Nagasawa,1,2 Ai Shibata,3 Hanako Fukamachi,4,5 Kaori Ishii,5 Rikard K Wicksell,6 Koichiro Oka5 1Department of Rehabilitation, Hasegawa Hospital, Yachimata, Chiba, Japan; 2Graduate School of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan; 3Faculty of Health and Sports Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan; 4Sport Sciences Laboratory, Japan Sport Association, Tokyo, Japan; 5Faculty of Sport Sciences, Waseda University, Saitama, Japan; 6Department of Clinical Neuroscience, Karolinska Institute, Stockholm, SwedenCorrespondence: Yasuhiro NagasawaDepartment of Rehabilitation, Hasegawa Hospital, 85 Yachimatani, Yachimata, Chiba, 289-1103, JapanTel +81 3 444 0137Fax +81 3 444 0807Email nagasawaid@toki.waseda.jpPurpose: The aim of this study was to translate the Psychological Inflexibility in Pain Scale Japanese version (PIPS-J) and inspect its validity and reliability in older patients with chronic low back pain and knee pain.Materials and Methods: The PIPS was translated into Japanese by a bilingual linguistic expert and three researchers and administered to 120 outpatients with low back pain and knee pain (61.7% women, age 73.8± 7.8 years). Construct validity and criterion validity were evaluated using confirmatory factor analysis and the correlations with the Acceptance and Action Questionnaire-II Japanese version (AAQ-II-J) and the Cognitive Fusion Questionnaire Japanese version (CFQ-J), respectively. Internal consistency using Cronbach’s alpha and test–retest reliability (n=43) were also examined.Results: Of all, 78.3% had low back pain, 55.6% had knee pain, and 44.2% both. The confirmatory factor analysis reproduced the original PIPS structure with two factors and indicated good model fit (GFI = 0.915, CFI = 0.970, RMSEA = 0.060). All items’ standardized regression weights ranged from 0.35 to 0.80. Criterion validity was shown by correlations of r = 0.58 for PIPS-J pain avoidance with the AAQ-II-J, and r = 0.45 between PIPS-J cognitive fusion and the CFQ-J. Cronbach’s alpha for the PIPS-J total score was α=0.85 (pain avoidance: 0.87; cognitive fusion: 0.68). The test–retest correlation for all 12 items was r = 0.54 (pain avoidance: 0.48; cognitive fusion: 0.54).Conclusion: Although a less relevant item was found on each of subscales, the PIPS-J appear to be fairly valid and reliable to evaluate psychological inflexibility in chronic pain among Japanese older adults.Keywords: pain avoidance, cognitive fusion, older patients, chronic low back pain, chronic knee pain

ABSTRACTBackground knee osteoarthritis is considered as one of the most important causes of knee pain. Conventional noninvasive lines of treatment are several, including platelet-rich plasma (PRP) that has been revealed to be helpful in the management of knee osteoarthritis. The goal of this study is to appraise the PRP ultrasound-guided injection in the management of knee osteoarthritis.Settings and Design This study was a prospective randomised double blind study.Methods Sixty adult knee osteoarthritis patients were involved in the current study. They were randomly selected from the pain clinic Faculty of Medicine, Alexandria University. There were two groups ultrasound-guided (USG) pulsed waves radiofrequency (PRF) ablation on genicular nerve (group 1) or intra-articular PRP (group 2) injection under ultrasonography (US)-guidance and articular surface RF ablation. Assessment was done applying visual analogue scale (VAS) for pain intensity. Functionally, WOMAC and IKDC scores were used at baseline and 6th month after injection.Results Intra-articular PRP (group 2) showed a significant improvement in pain severity and physical limitations in patients with knee pain. It also showed significant improvement compared to genicular nerve RF considering VAS score with p value (0.012*) up to 12 months follow up, WOMAC, IKDC scores with p value (

Introduction: Radiofrequency (RF) treatment of the genicular nerves is a promising treatment for chronic osteoarthritic and persistent postsurgical knee pain (PPSP), refractory to conventional medical management. Methods: The RECORGEN study is a retrospective single‐center cohort study of patients treated with ultrasound‐guided conventional RF of the genicular nerves for chronic knee pain in Hospital Oost‐Limburg, Genk from September 2017 to June 2020. Subgroup analysis based on etiology of pain (PPSP and degenerative knee pain) was performed in addition to the total study population analysis. Outcome parameters were global perceived effect (GPE), Numeric Rating Scale for pain, consumption of strong opioids, and safety of the treatment at 6 weeks and cross‐sectionally at a variable time point. Treatment success was defined as GPE≥50%. Results: Sixty‐eight cases were screened of which 59 (46 diagnosed with PPSP and 13 with degenerative knee pain) were included in the study. Treatment success at 6 weeks was achieved in 19 of 59 interventions (32.2%) and was similar in both groups. Seventeen responders were evaluated at follow‐up. 45.1% (8/17) continued to have a positive effect at the second time point. The mean duration of effect of the RF treatment was 8.3 months. Safety analysis at 6 weeks and at the second time point showed a good safety profile of the treatment. Conclusion: Conventional RF of the genicular nerves was clinically successful in more than 30% of the study population refractory to conventional medical management. Overall, the treatment was well tolerated. The mean duration of effect was 8.3 months. [ABSTRACT FROM AUTHOR]

Introduction: Synovial hemangioma of the knee is a benign vascular malformation that is often misdiagnosed due to its non-specific symptoms., Case Report: We present a case involving a 7-year-old male child with chronic knee pain and swelling in the left knee, which remained undiagnosed for over 3 years. Magnetic resonance imaging revealed a synovial vascular malformation. Surgical excision of the lesion and partial synovectomy were performed, and histopathological analysis confirmed the diagnosis of synovial hemangioma. After 18 months of follow-up, there were no signs of recurrence or recurrent joint effusion., Conclusion: Synovial hemangioma of the knee, although uncommon, should be considered as a differential diagnosis in cases of chronic knee pain and swelling. En-bloc excision is the treatment of choice to prevent recurrence, yielding good clinical outcomes., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Introduction: Chronic knee pain often results from degenerative conditions such as knee osteoarthritis (OA) and can worsen after surgical interventions like total knee arthroplasty (TKA). Knee OA affects approximately 86 million individuals globally, leading to decreased function, mobility limitations, and disability. While TKA is a common surgical treatment for refractory knee OA, though up to 20 % of patients experience chronic post-operative knee pain worse than their pre-operative pain. Genicular nerve radiofrequency ablation (GnRFA) has emerged as a promising intervention for knee OA pain unresponsive to conservative management and for chronic post-TKA pain. GnRFA is an evidence-based technique supported by multiple prospective cohort studies and randomized controlled trials (RCTs). However, practice patterns and GnRFA techniques vary, and no peer-reviewed publication has yet quantified these variations in real-world clinical practice., Objective: This study aims to understand the practice patterns of interventional pain physicians regarding patient selection, use of prognostic blocks, imaging, nerve targets, GnRFA types, and GnRFA techniques in treating knee pain secondary to OA or persistent post-TKA pain., Methods: An anonymous 29-question survey was distributed via electronic mail to members of the International Pain and Spine Intervention Society (IPSIS) from January 16, 2024, to February 29, 2024. The survey assessed practice patterns related to patient selection, prognostic block use, and GnRFA techniques. Data were collected and stored using REDCap software, with descriptive statistics calculated., Results: A total of 150 completed surveys were analyzed, representing a completion rate of 2.0 % of surveys sent, 3.5 % of emails opened, and 56.8 % of those who clicked on the survey link. Respondents generally use common selection protocols regarding OA grade (Kelgren-Lawrence 3 and 4), duration of failed conservative care (3-6 months), a single anesthetic block paradigm, and use of fluoroscopic guidance for the GnRFA procedure. More variability was reported between respondents regarding the volume of anesthetic used during prognostic blocks, the threshold to consider a prognostic block "positive," the technology used, and nerves targeted during the GnRFA procedure., Conclusion: The study provides valuable insights into the current practice patterns of GnRFA among interventional pain physicians. While there is consensus on some aspects of patient selection and procedural techniques, significant variability exists in prognostic block protocols and nerve targets for GnRFA. These findings highlight the need for further research to explore the long-term efficacy and safety of GnRFA and to standardize techniques and protocols across different practice settings, ultimately improving patient outcomes and quality of life. The low response rate may limit generalizability, and the survey did not include data on active tip sizes used for ablation or whether other procedures should be exhausted before resorting to GnRFA. Additionally, a survey to IPSIS membership only may not fully represent a diverse cohort of pain management specialists, potentially introducing sampling bias. Future studies should include members from a broader range of professional organizations to enhance representativeness., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Co-Authors: 1) Taylor Burnham, DO MS receives research grant funding from DIROS technology (paid directly to the University of Utah) and does consulting work with AVANOS Medical. 2) Zachary L. McCormick, MD serves on the Board of Directors of the International Pain and Spine Intervention Society (IPSIS), has research grants from Avanos Medical, Boston Scientific, Relievant Medsystems, Saol Therapeutics, Spine Biopharma, SPR Therapeutics, Stratus Medical (paid directly to the University of Utah), and also consultancies with Avanos Medical, Saol Therapetuics, Stryker, and OrthoSon.If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

knee osteoarthritis is considered as one of the most important causes of knee pain. Conventional noninvasive lines of treatment are several, including platelet-rich plasma (PRP) that has been revealed to be helpful in the management of knee osteoarthritis. The goal of this study is to appraise the PRP ultrasound-guided injection in the management of knee osteoarthritis. This study was a prospective randomised double blind study. Sixty adult knee osteoarthritis patients were involved in the current study. They were randomly selected from the pain clinic Faculty of Medicine, Alexandria University. There were two groups ultrasound-guided (USG) pulsed waves radiofrequency (PRF) ablation on genicular nerve (group 1) or intra-articular PRP (group 2) injection under ultrasonography (US)-guidance and articular surface RF ablation. Assessment was done applying visual analogue scale (VAS) for pain intensity. Functionally, WOMAC and IKDC scores were used at baseline and 6th month after injection. Intra-articular PRP (group 2) showed a significant improvement in pain severity and physical limitations in patients with knee pain. It also showed significant improvement compared to genicular nerve RF considering VAS score with p value (0.012*) up to 12 months follow up, WOMAC, IKDC scores with p value (<0.001*) up to 12 months and US joint assessment with p value (0.028*) up to 6 months follow up. The use of US IA-PRP injection combined to pulsed radiofrequency ablation of articular surface show significant improvement in pain compared to the genicular nerve PRF. [ABSTRACT FROM AUTHOR]

Extradigital localizations of glomus tumors (GTs) remain rare and can often lead to missed or delayed diagnosis due to nonspecific symptoms. In this article, we report a case of a GT with a rare localization in the proximal third of the lower leg. [ABSTRACT FROM AUTHOR]

Background: Ultrasound-guided genicular nerve blocks (GNBs) in the emergency department (ED) have easily identifiable anatomic targets and offer an opportunity to provide safe, effective, motor-sparing analgesia for acute knee pain. Case Report A 68-year-old woman presented with acute, 8/10 right knee pain due to an isolated right lateral tibial plateau fracture. After informed consent and with the ultrasound in the sagittal plane, the superior lateral (SLGN), superior medial (SMGN), and inferior medial (IMGN) genicular nerves were identified at the junction of their respective femoral or tibial epicondyle and femoral or tibial epiphysis. The skin was anesthetized and an echogenic needle was inserted under ultrasound guidance to inject 1.0 mL of 0.5% bupivacaine around the right SLGN, SMGN, and IMGN. Approximately 30 minutes after the GNBs, the patient reported 0/10 pain at rest and 1/10 pain with movement. She did not require opioids during her ED visit or upon discharge. Why Should an Emergency Physician Be Aware of This? GNBs show promise as a useful tool to provide acute and medium-term motor-sparing analgesia in a patient with acute knee pain. GNBs have easy-to-recognize anatomic targets on ultrasound and may be a suitable adjunct or alternative to a multimodal pain regimen in the emergency department. [ABSTRACT FROM AUTHOR]

Abstract Background An increasing amount of evidence supports an association between sedentary behaviors and chronic knee pain. However, the association between the total daily duration of sedentary behavior and chronic knee pain in the general population remains unclear. We aimed to analyze the association between sedentary behavior and chronic knee pain in a study population representative of the general Korean population aged > 50 years while also considering the physical activity or body mass index (BMI). Methods This cross-sectional study used data from the 6th Korean National Health and Nutrition Examination Survey (KNHANES VI) of 2013–2015, which was completed by 22,948 Korean adult participants aged > 50 years. The participants were divided into two groups based on the status of the chronic knee pain. Data were analyzed using multivariable logistic regression after adjustment for age, sex, and individual factors. Results Longer sedentary behavior was correlated with chronic knee pain (p for trend = 0.02). Sedentary behavior exceeding 10 h/day was significantly associated with chronic knee pain (adjusted odds ratio, 1.28; p = 0.03). Participants with high levels of physical activity were less likely to suffer from chronic knee pain (adjusted odds ratio, 0.78; p = 0.00), and women with over 10 daily hours of sedentary behavior with high levels of physical activity were more likely to have chronic knee pain. A significant association was noted between chronic knee pain and obesity (≥30.0 kg/m2) individuals (adjusted odds ratio, 3.48; p = 0.04). Conclusions Longer duration of sedentary behaviors was correlated with chronic knee pain. Our study suggests the need to encourage reductions in overall sedentary behavior to 50 years and those with obesity.

Introduction: Chronic knee pain is a common musculoskeletal condition, which usually leads to decreased quality of life and a substantial financial burden. Various non-surgical treatments have been developed to relieve pain, restore function and delay surgical intervention. Research on the benefits of medical cannabis (MC) is emerging supporting its use for chronic pain conditions. The purpose of this study was to evaluate the cost-effectiveness of MC compared to current non-surgical therapies for chronic knee pain conditions. Methods: We conducted a cost-utility analysis from a Canadian, single payer perspective and compared various MC therapies (oils, soft gels and dried flowers at different daily doses) to bracing, glucosamine, pharmaceutical-grade chondroitin oral non-steroidal anti-inflammatory drugs (NSAIDs), and opioids. We estimated the quality-adjusted life years (QALYs) gained with each treatment over 1 year and calculated incremental cost-utility ratios (ICURs) using both the mean and median estimates for costs and utilities gained across the range of reported values. The final ICURs were compared to willingness-to-pay (WTP) thresholds of $66 714, $133 428 and $200 141 Canadian dollars (CAD) per QALY gained. Results: Regardless of the estimates used (mean or median), both MC oils and soft gels at both the minimal and maximal recommended daily doses were cost-effective compared to all current knee pain therapies at the lowest WTP threshold. Dried flowers were only cost-effective up to a certain dosage (0.75 and 1 g/day based on mean and median estimates, respectively), but all dosages were cost-effective when the WTP was increased to $133 428/QALY gained. Conclusion: Our study showed that MC may be a cost-effective strategy in the management of chronic knee pain; however, the evidence on the medical use of cannabis is limited and predominantly low-quality. Additional trials on MC are definitely needed, specifically in patients with chronic knee pain. [ABSTRACT FROM AUTHOR]

Periarticular calcification of the knee joint is a rare pathology that may be challenging to diagnose and manage when symptomatic. Here, we describe the first use of fluoroscopic-guided percutaneous needle aspiration and lavage (barbotage) with corticosteroid injection in a case of symptomatic calcification of the lateral collateral ligament (LCL). A 75-year-old female presented with acute lateral knee pain and stiffness, which subsequent radiographic imaging and diagnostic injection confirmed to be attributed to calcification within the LCL. Initial treatment with analgesic medications and a genicular nerve block failed to alleviate symptoms. However, complete resolution of symptoms was achieved following fluoroscopic-guided barbotage and steroid injection. This case underscores the importance of considering LCL calcification in the differential diagnosis of lateral knee pain. This case also illustrates the potential effectiveness of barbotage and adjunctive steroid injection as a minimally invasive treatment option for symptomatic LCL calcification, emphasizing the need for more rigorous studies evaluating treatment strategies for managing periarticular calcifications involving the knee joint., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Deschler et al.)

Knee arthroplasty is done to relieve pain. The procedure itself can cause long lasting pain which can significantly decrease the quality of life and mobility. The factors leading to pe rsistent pain relate to patient and surgery and the management of pain before and after the surgery. The management of persistent arthroplasty pain is multidisciplinary and involves conservative and interventional pain medicine.

The article presents the discussion on Total knee arthroplasty (TKA) being one of the most common and efficacious ways managing severe knee osteoarthritis. Topics include proposed pathophysiological mechanisms for the development of neuropathic pain mainly of mechanical forces during surgery; and dorsal root ganglion stimulation (DRG-S) emerging as a potential long-term solution for chronic post-TKA pain.

Objective: To determine the association between selected biomechanical variables and risk of patellofemoral pain (PFP) in males and females. Design: Prospective cohort. Setting: US Service Academies. Participants: Four thousand five hundred fortythree cadets (1727 females and 2816 males). Assessment of risk factors: Three-dimensional biomechanics during a jumplanding task, lower-extremity strength, Q-angle, and navicular drop. Main outcome measures: Cadets were monitored for diagnosis of PFP during their enrollment in a service academy. Three-dimensional hip and knee kinematic data were determined at initial contact (IC) and at 50% of the stance phase of the jump-landing task. Logistic regression analyses were performed for each risk factor variable in males and females (P<0.05). Results: Less than 10 degrees of hip abduction at IC [odds ratio (OR)=1.86, P =0.03] and greater than 10 degrees of knee internal rotation at 50% of the stance phase (OR=1.71, P=0.02) increased the risk of PFP in females. Greater than 20 degrees of knee flexion at IC (OR = 0.47, P < 0.01) and between 0 and 5 degrees of hip external rotation at 50% of the stance phase (OR = 0.52, P = 0.04) decreased the risk of PFP in males. No other variables were associated with risk of developing PFP (P < 0.05). Conclusions: The results suggest males and females have differing kinematic risk factor profiles for the development of PFP. Clinical relevance: To most effectively reduce the risk of developing PFP, the risk factor variables specific to males (decreased knee flexion and increased hip external rotation) and females (decreased hip abduction and increased knee internal rotation) should be addressed in injury prevention programs. [ABSTRACT FROM AUTHOR]

Introduction: People do health care not only to diagnose and relieve pain but also to reduce pain, anxiety, and loneliness in their daily lives. The present study aims to evaluate the effectiveness of Morita therapy among older women suffering from emotional distress and social isolation with chronic knee pain. Methods: The research method was pretest - posttest with a control group. The statistical population of the study included the older adults with chronic knee pain in the period of May to August 2020 in Tabriz, Iran. The sample consisted of 30 female patients aged 60-70 years with chronic knee pain who entered the study by convenience sampling method and randomly assigned to experimental and control group (15 patients each group). The research instruments included the Depression Anxiety and Stress Scale (DASS-21) and the Lubben Social Network Scale (LSNS). In the experimental group, Morita therapy was held during nine sessions for 90 minutes once a week. Results: The results of multivariate analysis of covariance showed significant effectiveness of Morita therapy on emotional distress and social isolation (p < 0.001). Morita therapy significantly reduced patients' depression and anxiety scores (Eta = 0.68). In addition, the social isolation scores of the experimental group significantly reduced compared to the control group (p < 0.001), which indicates an increase in the quality of social network (Eta = 0.49). Conclusion: Morita therapy can help reduce emotional distress and social isolation in older women with chronic knee pain and can be used in conjunction with other common therapies. [ABSTRACT FROM AUTHOR]

The painful knee is one of the most common musculoskeletal presentations to primary and secondary care. It is important to distinguish between acute and chronic causes of knee pain, since the urgency of diagnosis and management can be vastly different. This short review covers the common diagnoses that are frequently encountered, with a systematic approach to confirming the diagnosis, and a management strategy. [ABSTRACT FROM AUTHOR]

To evaluate the effectiveness of neurophysiological pain education in patients with symptomatic knee osteoarthritis considering pain-related variables. A systematic review and meta-analysis was carried out according to the PRISMA guidelines. A search was conducted in PubMed, PEDro Database, Cochrane Library, Scopus, and Web of Science. Only randomized controlled trials enrolling patients ≥ 18 years of age with symptomatic knee osteoarthritis were included. The Downs and Black quality assessment tool was used to assess the quality of the articles, and the risk of bias was evaluated with the Cochrane Risk of Bias Assessment Tool. A total of 7 studies were included in the study. Most of the studies were rated as "fair" on the Downs and Black quality assessment tool, and in the category of "some concerns" according to the Cochrane Risk of Bias Assessment Tool. Neurophysiological pain education was conducted alone or combined with exercise, joint mobilizations, or self-management programs. The number of sessions ranged from 1 to 10. The meta-analysis results showed significant differences in favor of the intervention group in pain (MD = −0.49; 95% CI = −0.66; −0.32; p < 0.001) and catastrophization (MD = −1.81; 95% CI = −3.31, −0.3; p = 0.02). Neurophysiological pain education interventions in isolation or combined with exercise, joint mobilizations, or self-management programs have proven to significantly improve pain and catastrophization in patients with symptomatic knee osteoarthritis. These findings could provide clinicians with more information regarding the management of patients with symptomatic knee osteoarthritis. ● Neurophysiological pain education have positive effects in symptomatic knee osteoarthritis. ● The positive effects are in pain severity and catastrophization. ● Neurophysiological pain education could be applied alone or combined. [ABSTRACT FROM AUTHOR]

Background and Aims: Monopolar radiofrequency ablation (MRFA) of the genicular nerve is effective in managing chronic knee pain from osteoarthritis (OA); however, the procedure itself is associated with significant pain due to manipulation of electrode to localise tiny genicular nerves. We hypothesised that inserting two electrodes to target the genicular nerves [bipolar radiofrequency ablation (BRFA)] without sensory localisation can decrease the procedural pain with equal analgesic efficacy in treating knee pain. Methods: Thirty patients with chronic knee pain due to OA were randomised to receive either MRFA (n = 15) or BRFA (n = 15), after having 50% pain relief with diagnostic genicular nerve block. Pain during the procedure (assessed by the Numeric Rating Scale [NRS]), time taken to do the procedure and complications were recorded. Knee pain was assessed by the Oxford Knee Score at baseline, 1 week, 1 month, 3 months and 6 months following the procedure. Results: Patients in both groups had good pain relief, and no difference in pain relief and the duration of pain relief was seen between the two groups. The median (range) NRS for procedural pain was significantly lower in the bipolar group [3 (3–5)] than in the monopolar group [5 (3–7), P = 0.013]. There was no significant difference in procedure time and no complications were seen in either group. Conclusion: BRFA is an effective alternative for ablation of genicular nerves in patients with knee pain due to OA. It causes less procedural pain compared with MRFA.

Abstract Background Detailed pain mapping of extent and distribution in individuals with patellofemoral pain (PFP) within and around a complex structure such as the knee has yet to be explored. Methods Perceptions of on-going pain from adolescents and young adults (N = 35) with long-standing (>10 months) PFP were collected on high-resolution 3D digital body-schema of the knees. Location, area of pain, pain intensity, laterality, worse side of knee pain, symptom duration, and symmetry in bilateral knee pain were recorded. A threshold for naturally occurring variations in symmetrical knee pain drawings were collected from 18 healthy controls and used in combination with the development a symmetry index (0–1) to create a fuzzy rule for classifying symmetrical and non-symmetrical PFP patterns as compared to a PFP expert. The symmetry index was computed and tested using a correlation coefficient alone or in combination with the Jaccard index and the true and false positive rates (TPR and FPR, respectively) determined. Results The peripatellar region was the common report of pain location however, novel and nonconforming PFP patterns were identified and the majority of individuals (22 of 27) with bilateral PFP expressed highly-symmetric mirror-image pain. Individuals with symptom duration of 5 years or more had a greater area of pain, compared to those with symptoms for less than 5 years. The total area of pain was correlated to symptom duration for those with extended symptoms durations and a progression towards an “O” shaped pattern emerged. A TPR of 100% for identifying symmetrical knee pain patterns was found however the expert PFP tended to be stricter, as reflected in FPR of 20%. Conclusions A high proportion of PFP patterns or symptoms occur in mirrored locations and are exceptionally symmetrical, and long duration of symptoms appear to converge to an ‘O’ shape. Classifying symmetrical pain patterns is subjective however simple fuzzy rules and correlations can be used to increase objectivity. This study highlights a gap in knowledge of PFP symptom presentation, reveals what may be a natural progression of symptoms, and provides valuable clinical insight for both pain management and treatment.

Chronic knee pain, affecting over 25% of adults in the United States, has surged by 65% over the past two decades leading to rising functional deficits, mobility problems, and a diminished quality of life. While conservative management with pharmacologic and minimally invasive injections are pursued early in the disease process, total knee arthroplasty for refractory osteoarthritis of the knee is often considered. This procedure usually improves pain and functionality within the first three months. However, a significant portion of patients often suffer from postoperative pain that can become chronic and debilitating. We detail the case of a patient with a previous TKA as well as a non-operable patella fracture who obtained significant relief with PNS despite prior conservative and minimally invasive management.