Chronic knee pain can be one of the most limiting problems a person deals with. Whether it comes from osteoarthritis, injury, or pain that lingered after a total knee replacement, it changes how you walk, sleep, and get through the day. Many patients have already tried corticosteroid injections, physical therapy, and oral medications. The relief was partial or it did not last.
Genicular nerve radiofrequency ablation is a minimally invasive procedure that targets the specific nerves sending pain signals from the knee to the brain. Instead of treating the knee joint broadly, we find the small nerve branches responsible for carrying the pain signal and interrupt them with heat energy. The joint itself is not altered, and no implant is left behind.
At our Nassau County pain management practice, we see patients from across Long Island who are looking for something more targeted than repeat injections but want to avoid or delay surgery. For the right patient, genicular nerve ablation can provide meaningful and lasting knee pain relief.
How the Genicular Nerves Work and Why Ablating Them Helps
The knee joint is supplied by several small nerve branches, primarily the medial and lateral superior genicular nerves and the medial inferior genicular nerve. These nerves carry pain signals from the joint capsule, the ligaments, and the bone. In a knee affected by arthritis or prior surgery, these nerves can become persistent sources of pain even when the joint itself has been replaced or treated in other ways.
Radiofrequency ablation uses a probe positioned near each nerve branch. A controlled heat lesion is created at the nerve, which interrupts its ability to transmit pain. Because these are small sensory nerves rather than motor nerves, the procedure does not affect your ability to move or control your leg.
The process requires two separate appointments. First, we perform a diagnostic genicular nerve block using local anesthetic. If that block reduces your pain by at least 50 percent, it confirms those nerves are a meaningful source of your discomfort and that ablation is likely to help. Patients who do not get enough relief from the block are generally not good candidates for the ablation step.
What the Research Shows
Clinical trials have supported this approach for knee osteoarthritis pain. In a well-designed randomized controlled trial, 59 to 65 percent of patients who underwent radiofrequency ablation of the genicular nerves achieved at least a 50 percent reduction in knee pain at one, four, and twelve weeks after the procedure, compared to a control group that did significantly worse.
Cooled radiofrequency technology, which creates a slightly larger lesion and may reach nerve branches more reliably, has also been studied. A series of patients treated with cooled RF showed sustained pain reduction at one, three, six, and twelve months, with no significant complications.
These are not small improvements. For patients who have spent months or years managing constant knee pain, this level of relief can change how they function at work, at home, and during activity.
Who Is a Good Candidate for This Procedure
Genicular nerve ablation is typically considered when someone meets a few basic criteria:
Chronic knee pain lasting at least three to six months
Diagnosis of knee osteoarthritis confirmed on imaging
At least moderate pain that is affecting function and quality of life
Prior conservative treatment such as physical therapy, oral medication, or corticosteroid injections without lasting relief
A positive response to a diagnostic genicular nerve block
We also consider this procedure for patients who have had a total knee replacement and still experience significant pain. After a knee replacement, the joint surfaces are gone, but the genicular nerve branches that supplied the original joint remain. In these cases, nerve ablation can target pain signals that persist even when the mechanical problem has been addressed surgically.
Patients who are not good candidates include those with very localized pain from an identifiable structural problem that requires surgery, or those who had a negative diagnostic block.
What to Expect Before, During, and After the Procedure
The ablation procedure is done in an outpatient or office-based setting. We use fluoroscopic imaging to guide the probe to each nerve branch with precision. Local anesthetic is used to keep you comfortable throughout. Most patients describe the procedure as tolerable, with some pressure or brief sensation during the positioning steps.
Afterward, you may notice temporary soreness around the treatment area, which usually settles within a few days. Relief does not always appear immediately. Because a small amount of inflammation occurs as the nerve heals following the ablation, some patients do not notice the full benefit until two to six weeks after the procedure.
Genicular nerves can regenerate over time, so the relief from this procedure is long-lasting rather than permanent. Many patients experience meaningful pain reduction for twelve months or more. When pain returns, the procedure can often be repeated.
Frequently Asked Questions About Genicular Nerve Ablation
Is genicular nerve ablation covered by insurance?
Coverage depends on your specific plan and diagnosis. Medicare and many commercial insurers cover this procedure when criteria are met, including documentation of prior failed conservative treatment and a positive diagnostic block. Our team can help verify your coverage before you schedule.
Does the procedure affect how my knee works?
No. The genicular nerves are sensory branches that carry pain signals. Ablating them does not interfere with motor function, meaning you will not lose strength or control of your leg.
How long does the relief last?
Most patients see meaningful improvement for twelve months or longer. Because nerves can regenerate, the procedure can typically be repeated when relief diminishes.
Can I still have knee surgery if I try this first?
Yes. Genicular nerve ablation does not limit your surgical options. Some patients use it as a bridge while waiting for surgery, and others find it provides enough relief that surgery becomes less urgent.
Next Steps for Knee Pain Patients on Long Island
If you have been living with chronic knee pain and have not found lasting relief from other treatments, genicular nerve ablation may be worth discussing. Dr. Edward Rubin serves patients from throughout Nassau County, Queens, and Long Island at our Garden City and New Hyde Park offices. Call us at 516-492-3100 or text 516-206-0774 to schedule a consultation.
Written by Dr. Edward Rubin, MD, board-certified in Pain Medicine and Anesthesiology, with fellowship training at Cornell, Columbia, Hospital for Special Surgery, and Memorial Sloan Kettering. Dr. Rubin has been treating chronic pain patients on Long Island for over 20 years.
