Laser denervation versus PRP for late-stage knee osteoarthritis: a prospective controlled study

Background: Knee osteoarthritis (OA) is a prevalent degenerative joint disorder characterized by chronic pain and functional impairment. While minimally invasive treatments like platelet-rich plasma (PRP) injections and genicular nerve denervation are used for advanced stages, their comparative efficacy requires further investigation.

Objective: To compare the effectiveness and safety of intra-articular PRP injections and laser genicular nerve denervation (LGND) in patients with late-stage knee OA.

Methods: In this prospective, randomized, controlled trial, 31 patients with Kellgren-Lawrence grade 3-4 gonarthrosis were allocated to either a single intra-articular injection of autologous PRP (n=16) or a percutaneous LGND procedure (n=15) targeting the superomedial, superolateral, and inferomedial genicular nerves under combined x-ray and ultrasonographic guidance. The primary outcomes were the change from baseline in Visual Analog Scale (VAS) pain scores and the Oswestry Disability Index (ODI) at 2 weeks, 3 months, and 6 months post-procedure.

Results: The LGND group demonstrated a statistically significant and greater reduction in both VAS and ODI scores at all follow-up intervals compared to the PRP group. No serious adverse events were reported in either group throughout the 6-month study period.

Conclusion: For patients with late-stage knee osteoarthritis, laser genicular nerve denervation provides superior and sustained pain relief and functional improvement over a single intra-articular PRP injection, with a comparable safety profile over six months.

1. Hsu H, Siwiec RM. Knee Osteoarthritis. 2023 Jun 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29939661.

2. Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine. 2020 Nov 26; 29-30: 100587. https://doi.org/10.1016/j.eclinm.2020.100587 PMID: 34505846; PMCID: PMC7704420.

3. Glyn-Jones S, Palmer AJ, Agricola R, Price AJ, Vincent TL, Weinans H, Carr AJ. Osteoarthritis. Lancet. 2015 Jul 25; 386 (9991): 376-87. https://doi.org/10.1016/S0140-6736(14)60802-3 Epub 2015 Mar 4. PMID: 25748615.

4. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019 Apr 27; 393 (10182): 1745-1759. https://doi.org/10.1016/S0140-6736(19)30417-9 PMID: 31034380.

5. Mobasheri A, Batt M. An update on the pathophysiology of osteoarthritis. Ann Phys Rehabil Med. 2016 Dec; 59 (5-6): 333-339. https://doi.org/10.1016/j.rehab.2016.07.004 Epub 2016 Aug 18. PMID: 27546496.

6. Lluch E, Torres R, Nijs J, Van Oosterwijck J. Evidence for central sensitization in patients with osteoarthritis pain: a systematic literature review. Eur J Pain. 2014 Nov; 18 (10): 1367-75. https://doi.org/10.1002/j.1532-2149.2014.499.x Epub 2014 Apr 3. PMID: 24700605.

7. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K, Harvey WF, Hawker G, Herzig E, Kwoh CK, Nelson AE, Samuels J, Scanzello C, White D, Wise B, Altman RD, DiRenzo D, Fontanarosa J, Giradi G, Ishimori M, Misra D, Shah AA, Shmagel AK, Thoma LM, Turgunbaev M, Turner AS, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020 Feb; 72 (2): 149-162. https://doi.org/10.1002/acr.24131. Epub 2020 Jan 6. Erratum in: Arthritis Care Res (Hoboken). 2021 May; 73 (5): 764. https://doi.org/10.1002/acr.24615 PMID: 31908149; PMCID: PMC11488261.

8. Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, Underwood M, McAlindon TE. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019 Nov; 27 (11): 1578-1589. https://doi.org/10.1016/j.joca.2019.06.011 Epub 2019 Jul 3. PMID: 31278997.

9. Bennell KL, Paterson KL, Metcalf BR, Duong V, Eyles J, Kasza J, Wang Y, Cicuttini F, Buchbinder R, Forbes A, Harris A, Yu SP, Connell D, Linklater J, Wang BH, Oo WM, Hunter DJ. Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial. JAMA. 2021 Nov 23; 326 (20): 2021-2030. https://doi.org/10.1001/jama.2021.19415 PMID: 34812863; PMCID: PMC8611484.

10. Dai WL, Zhou AG, Zhang H, Zhang J. Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Trials. Arthroscopy. 2017 Mar; 33 (3): 659-670.e1. https://doi.org/10.1016/j.arthro.2016.09.024 Epub 2016 Dec 22. PMID: 28012636.

11. Xiong Y, Gong C, Peng X, Liu X, Su X, Tao X, Li Y, Wen Y, Li W. Efficacy and safety of platelet-rich plasma injections for the treatment of osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne). 2023 Jun 27 ;10: 1204144. https://doi.org/10.3389/fmed.2023.1204144. PMID: 37441691; PMCID: PMC10333515.

12. Xiong Y, Gong C, Peng X, Liu X, Su X, Tao X, Li Y, Wen Y, Li W. Efficacy and safety of platelet-rich plasma injections for the treatment of osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne). 2023 Jun 27; 10: 1204144. https://doi.org/10.3389/fmed.2023.1204144 PMID: 37441691; PMCID: PMC10333515.

13. Diaz Haaz DI, Rizo Castro O. Efficacy and Safety of Intra-articular Platelet-Rich Plasma (PRP) Versus Corticosteroid Injections in the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Clinical Trials. Cureus. 2025 Mar 21; 17 (3): e80948. https://doi.org/10.7759/cureus.80948 PMID: 40260368; PMCID: PMC12010028.

14. Glinkowski WM, Gut G, Śladowski D. Platelet-Rich Plasma for Knee Osteoarthritis: A Comprehensive Narrative Review of the Mechanisms, Preparation Protocols, and Clinical Evidence. J Clin Med. 2025 Jun 5; 14 (11): 3983. https://doi.org/10.3390/jcm14113983 PMID: 40507744; PMCID: PMC12156035.

15. Du D, Liang Y. A meta-analysis and systematic review of the clinical efficacy and safety of platelet-rich plasma combined with hyaluronic acid (PRP + HA) versus PRP monotherapy for knee osteoarthritis (KOA). J Orthop Surg Res. 2025 Jan 17; 20 (1): 57. https://doi.org/10.1186/s13018-024-05429-w PMID: 39819683; PMCID: PMC11740359.

16. Choi WJ, Hwang SJ, Song JG, Leem JG, Kang YU, Park PH, Shin JW. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain. 2011 Mar; 152 (3): 481-487. https://doi.org/10.1016/j.pain.2010.09.029 Epub 2010 Nov 4. PMID: 21055873.

17. Davis T, Loudermilk E, DePalma M, Hunter C, Lindley D, Patel N, Choi D, Soloman M, Gupta A, Desai M, Buvanendran A, Kapural L. Prospective, Multicenter, Randomized, Crossover Clinical Trial Comparing the Safety and Effectiveness of Cooled Radiofrequency Ablation With Corticosteroid Injection in the Management of Knee Pain From Osteoarthritis. Reg Anesth Pain Med. 2018 Jan; 43 (1): 84-91. https://doi.org/10.1097/AAP.0000000000000690 PMID: 29095245; PMCID: PMC5768219.

18. El-Hakeim EH, Elawamy A, Kamel EZ, Goma SH, Gamal RM, Ghandour AM, Osman AM, Morsy KM. Fluoroscopic Guided Radiofrequency of Genicular Nerves for Pain Alleviation in Chronic Knee Osteoarthritis: A Single-Blind Randomized Controlled Trial. Pain Physician. 2018 Mar; 21 (2): 169-177. PMID: 29565947.

19. Conger A, Gililland J, Anderson L, Pelt CE, Peters C, McCormick ZL. Genicular Nerve Radiofrequency Ablation for the Treatment of Painful Knee Osteoarthritis: Current Evidence and Future Directions. Pain Med. 2021 Jul 25; 22 (Suppl 1): S20-S23. https://doi.org/10.1093/pm/pnab129 PMID: 34308957.

20. McCormick ZL, Korn M, Reddy R, Marcolina A, Dayanim D, Mattie R, Cushman D, Bhave M, McCarthy RJ, Khan D, Nagpal G, Walega DR. Cooled Radiofrequency Ablation of the Genicular Nerves for Chronic Pain due to Knee Osteoarthritis: Six-Month Outcomes. Pain Med. 2017 Sep 1; 18 (9): 1631-1641. https://doi.org/10.1093/pm/pnx069 PMID: 28431129.

21. Chen AF, Khalouf F, Zora K, DePalma M, Kohan L, Guirguis M, Beall D, Loudermilk E, Pingree M, Badiola I, Lyman J. Cooled Radiofrequency Ablation Compared with a Single Injection of Hyaluronic Acid for Chronic Knee Pain: A Multicenter, Randomized Clinical Trial Demonstrating Greater Efficacy and Equivalent Safety for Cooled Radiofrequency Ablation. J Bone Joint Surg Am. 2020 Sep 2; 102 (17): 1501-1510. https://doi.org/10.2106/JBJS.19.00935. PMID: 32898379.

22. Eskandar E, Kumar H, Boini A, Velasquez Botero F, El Hunjul GN, Nieto Salazar MA, Quinonez J, Dinh B, Mouhanna JE. The Role of Radiofrequency Ablation in the Treatment of Trigeminal Neuralgia: A Narrative Review. Cureus. 2023 Mar 15; 15 (3): e36193. https://doi.org/10.7759/cureus.36193 PMID: 37065382; PMCID: PMC10104592.

23. Cosman ER Jr, Dolensky JR, Hoffman RA. Factors that affect radiofrequency heat lesion size. Pain Med. 2014 Dec; 15 (12): 2020-36. https://doi.org/10.1111/pme.12566 Epub 2014 Oct 14. PMID: 25312825.

24. Filardo G, Kon E, Di Martino A, Di Matteo B, Merli ML, Cenacchi A, Fornasari PM, Marcacci M. Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial. BMC Musculoskelet Disord. 2012 Nov 23; 13: 229. https://doi.org/10.1186/1471-2474-13-229 PMID: 23176112; PMCID: PMC3532098.

25. A. V. Lychagin, A. V. Garkavi, O. I. Isleiikh, P. I. Katunyan, D. S. Bobrov, R. KH. Yavlieva, E. YU. Tselishcheva Ehffektivnost' vnutrikostnogo vvedeniya autologichnoi obogashchennoi trombotsitami plazmy v zonu oteka kostnogo mozga pri osteoartroze kolennogo sustava Vestnik RGMU. 2019;4

26. Shen, L., Yuan, T., Chen, S. et al. The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 12, 16 (2017). https://doi.org/10.1186/s13018-017-0521-3

27. Hohmann E, Tetsworth K, Glatt V. Is platelet-rich plasma effective for the treatment of knee osteoarthritis? A systematic review and meta-analysis of level 1 and 2 randomized controlled trials. Eur J Orthop Surg Traumatol. 2020 Aug; 30 (6): 955-967. https://doi.org/10.1007/s00590-020-02623-4 Epub 2020 Feb 14. PMID: 32060630.

28. Jamison DE, Cohen SP. Radiofrequency techniques to treat chronic knee pain: a comprehensive review of anatomy, effectiveness, treatment parameters, and patient selection. J Pain Res. 2018 Sep 18; 11: 1879-1888. https://doi.org/10.2147/JPR.S144633 PMID: 30271194; PMCID: PMC6151104.

29. Patel N, Gross A, Brown L, Gekht G. A randomized, placebo-controlled study to assess the efficacy of lateral branch neurotomy for chronic sacroiliac joint pain. Pain Med. 2012 Mar; 13 (3): 383-98. https://doi.org/10.1111/j.1526-4637.2012.01328.x Epub 2012 Feb 2. PMID: 22299761.

30. Kul'chitskaya Detelina Borisovna, Konchugova Tat'yana Venediktovna, Sravnitel'naya otsenka deistviya vysokointensivnogo i nizkointensivnogo lazernogo izlucheniya na sostoyanie mikrotsirkulyatsii u bol'nykh gonartrozom. Fizioterapevt. 2015;6.

31. McCormick ZL, Reddy R, Korn M, Dayanim D, Syed RH, Bhave M, Zhukalin M, Choxi S, Ebrahimi A, Kendall MC, McCarthy RJ, Khan D, Nagpal G, Bouffard K, Walega DR. A Prospective Randomized Trial of Prognostic Genicular Nerve Blocks to Determine the Predictive Value for the Outcome of Cooled Radiofrequency Ablation for Chronic Knee Pain Due to Osteoarthritis. Pain Med. 2018 Aug 1; 19 (8): 1628-1638. https://doi.org/10.1093/pm/pnx286 PMID: 29300971.

32. Kidd VD, Strum SR, Strum DS, Shah J. Genicular Nerve Radiofrequency Ablation for Painful Knee Arthritis: The Why and the How. JBJS Essent Surg Tech. 2019 Mar 13; 9 (1): e10. https://doi.org/10.2106/JBJS.ST.18.00016 PMID: 31333900; PMCID: PMC6635137.

33. Santana Pineda MM, Vanlinthout LE, Moreno Martín A, van Zundert J, Rodriguez Huertas F, Novalbos Ruiz JP. Analgesic Effect and Functional Improvement Caused by Radiofrequency Treatment of Genicular Nerves in Patients With Advanced Osteoarthritis of the Knee Until 1 Year Following Treatment. Reg Anesth Pain Med. 2017 Jan/Feb; 42 (1): 62-68. https://doi.org/10.1097/AAP.0000000000000510 PMID: 27875368.

34. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD005328. doi: 10.1002/14651858.CD005328.pub2. Update in: Cochrane Database Syst Rev. 2015 Oct 22; (10): CD005328. https://doi.org/10.1002/14651858.CD005328.pub3 PMID: 16625636.

35. Arendt-Nielsen L, Nie H, Laursen MB, Laursen BS, Madeleine P, Simonsen OH, Graven-Nielsen T. Sensitization in patients with painful knee osteoarthritis. Pain. 2010 Jun; 149 (3): 573-581. https://doi.org/10.1016/j.pain.2010.04.003 Epub 2010 Apr 24. PMID: 20418016.

36. Elawamy A, Kamel EZ, Mahran SA, Abdellatif H, Hassanien M. Efficacy of Genicular Nerve Radiofrequency Ablation Versus Intra-Articular Platelet Rich Plasma in Chronic Knee Osteoarthritis: A Single-Blind Randomized Clinical Trial. Pain Physician. 2021 Mar; 24 (2): 127-134. PMID: 33740345.

37. Dell'Isola A, Allan R, Smith SL, Marreiros SS, Steultjens M. Identification of clinical phenotypes in knee osteoarthritis: a systematic review of the literature. BMC Musculoskelet Disord. 2016 Oct 12; 17(1): 425. https://doi.org/10.1186/s12891-016-1286-2 PMID: 27733199; PMCID: PMC5062907.