Genicular nerve radiofrequency ablation for the treatment of chronic knee pain: systematic review with Bayesian network meta-analysis.

OBJECTIVE

To evaluate the effectiveness of genicular nerve radiofrequency ablation (GnRFA) for chronic knee pain via a systematic review and Bayesian network meta-analysis.

METHODS

Ovid MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched through November 2, 2025, for studies of adults ≥18 years of age with chronic knee pain due to osteoarthritis or persistent postsurgical pain who received the intervention GnRFA. Comparison groups received sham, chemoneurolysis, other active treatments, or no comparator. Outcomes were the proportions of individuals with numeric rating scale or visual analog rating scale reductions of ≥50% or ≥2 points at 1, 3, 6, and 12 months. Bayesian network meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was reported according to the PRISMA guidelines. For risk-of-bias assessment, Cochrane Risk of Bias 2, Risk of Bias In Non-Randomized Studies of Interventions, and National Heart, Lung, and Blood Institute quality-assessment tools were used.

RESULTS

The search identified 1740 records, with 358 full texts reviewed and 29 studies included (13 randomized controlled trials and 16 observational studies, totaling 2285 participants). GnRFA was most likely to be the highest-ranked treatment for chronic knee pain relief at 1 month (86.3%), 3 months (75.3%), 6 months (74.3%), and 12 months (75.0%) when compared with sham, intra-articular joint injections, and chemical neurolysis.

CONCLUSIONS

GnRFA serves as an effective treatment for chronic knee pain from either osteoarthritis or persistent postsurgical pain for at least 12 months. Additionally, it was found to be more effective than sham for at least 6 months.

STUDY REGISTRATION: The study protocol was registered in the systematic review registry PROSPERO (https://www.crd.york.ac.uk/PROSPERO; ID1179765).