Summary

The combination of bone marrow aspirate (BMA) and pulsed radiofrequency (PRF) offers a promising, minimally invasive approach for managing chronic knee osteoarthritis (KOA) pain. This technique, which leverages the regenerative potential of stem cells and the neuromodulatory effects of PRF, can significantly enhance pain relief and improve function, making it a relevant option for orthopedic clini

Abstract

Knee osteoarthritis (KOA) is a chronic degenerative disease prevalent in the elderly, especially in women, causing severe pain and difficulty in daily activities. Common treatments include surgery and joint injections. In cases refractory to conservative treatment, ultrasound-guided saphenous nerve block and pulsed radiofrequency (PRF) are effective options for analgesia. PRF, a technique that uses short pulses of radiofrequency combined with bone marrow aspirate (BMA), an autologous biological material composed of stem cells and growth factors, offers a new approach for the management of pain and inflammation in KOA, promoting prolonged pain relief and improved function. This study proposes a combined technique of BMA and PRF as a promising approach in regenerative medicine for pain control in chronic knee osteoarthritis.

KEYWORDS: Bone marrow cells, pulsed radiofrequency, saphenous nerve, knee osteoarthritis, chronic pain, regenerative medicine.

Introduction

Osteoarthritis (OA) is a chronic and progressive disease characterized by severe pain, joint stiffness, and limited range of motion, especially in the elderly. The inflammatory process in OA involves proinflammatory cytokines, such as IL-1β and TNF-α, which contribute to the degradation of the extracellular matrix and chondrocyte apoptosis. Although there are surgical and nonsurgical treatment options, such as arthroscopy, osteotomy, arthroplasty, lifestyle changes, and use of NSAIDs, many patients continue to have refractory pain. Less invasive techniques, such as ultrasound-guided peripheral nerve block and PRF, have demonstrated efficacy in modulating neuropathic pain.

TECHNIQUES

Ultrasound-guided saphenous nerve block is performed with the patient in the prone position, using a linear transducer to identify target points along the femoral artery. After visualization of the nerve, an anesthetic solution is injected at the level of the adductor canal. PRF is applied to the saphenous nerve to promote analgesia through neuromodulation, without causing significant thermal damage. For BMA use, autologous aspirate is collected from the posterior iliac crest using sterile technique. After collection, 10ml of BMA is injected into the joint space of the affected knee and the other 10ml along the saphenous nerve, followed by application of PRF under the parameter of 45V, 20ms wave weight, 2 Hz, 42oC, for 10 minutes.

Conclusion

The combination of bone marrow aspirate (BMA) and pulsed radiofrequency (PRF) in the management of knee osteoarthritis pain represents a promising and minimally invasive approach. Evidence suggests that these techniques, when combined, can significantly improve clinical outcomes, such as pain relief and functional improvement, financial viability and rapid recovery after the procedure, increasing patients' quality of life. Additional studies are needed to validate the application and identify the patients who benefit most from this therapeutic combination.