Clinical Outcomes and Repeat-CRFA-Free Survival After Ultrasound-Guided Cooled Radiofrequency Ablation Using the Matsuoka Direct Nerve Targeting (MDNT) Technique for Knee Osteoarthritis: A Retrospective Cohort Study of 1,025 Consecutive Knees.

BACKGROUND

Cooled radiofrequency ablation (CRFA) is a minimally invasive treatment for knee osteoarthritis (KOA) pain. Conventional techniques commonly use anatomical landmarks to estimate genicular nerve location. The Matsuoka Direct Nerve Targeting (MDNT) Technique combines ultrasound visualization with physiological confirmation before ablation. We evaluated clinical outcomes and repeat-CRFA-free survival after CRFA using this technique.

METHODS

This retrospective single-center cohort included 1,025 consecutive knees with symptomatic KOA treated between June 2024 and June 2026. NRS pain scores were recorded preoperatively, on postoperative day 1, and at approximately 1 year when available through rolling telephone follow-up. Repeat CRFA, complications, and conversion to total knee arthroplasty were secondary outcomes. Repeat-CRFA-free survival was estimated using Kaplan-Meier analysis.

RESULTS

Among 1,021 knees with complete early NRS data, mean NRS decreased from 7.76 ± 1.31 preoperatively to 2.46 ± 1.93 on postoperative day 1 (mean reduction, 5.29; 95% CI, 5.16-5.43; P < 0.001). One-year NRS data were available for 246 knees, in which mean NRS decreased from 8.15 ± 1.12 preoperatively to 2.29 ± 2.06 at approximately 1 year. Repeat CRFA was performed in 8 of 1,025 knees (0.8%; 95% CI, 0.4-1.5%), and TKA was reported as planned in 1 knee (0.1%). Kaplan-Meier repeat-CRFA-free survival was 99.8% at 12 months and 96.9% at 20 months. No major procedure-related complications were observed.

CONCLUSION

Ultrasound-guided CRFA using MDNT was associated with substantial early pain reduction, sustained pain relief among knees with available one-year follow-up, a low observed repeat-CRFA rate, and a favorable safety profile. Because this was a retrospective single-center, single-operator study without a comparator, the findings are hypothesis-generating and do not establish superiority over established techniques. Prospective multicenter comparative studies are warranted.