Genicular Artery Embolization for Chronic Knee Pain: Expert Consensus Recommendations on Indications, Technique and Clinical Care Using a Delphi Process
Year: 2026
Type: article
Abstract: PURPOSE: To develop expert-consensus recommendations for patient selection, technique and clinical management in genicular artery embolization (GAE) using a Delphi process. MATERIALS AND METHODS: A working group developed a 75-statement questionnaire. A panel of musculoskeletal and interventional radiologists (IRs), selected based on clinical experience, scientific expertise and geographic diversity, scored each response using a 10-point Likert-scale across three rounds. Consensus was predefined as ≥ 75% of ratings ≥ 7/10. RESULTS: Twenty-nine IRs completed all three rounds. Consensus inclusion criteria for GAE include knee pain refractory to conservative treatment for ≥ 3 months due to osteoarthritis, tendinopathies or prior knee surgery and recurrent hemarthrosis (median 9[IQR 7-10]; 86% ≥ 7). Pre-procedural assessment should include standardized outcome measures, clinical examination and knee radiographs. Contrast-enhanced MRI is optional for osteoarthritis phenotyping and grading of synovitis, differential diagnosis and outcome prediction (8[7-10]; 79% ≥ 7). Via an ipsilateral antegrade transfemoral access, all visible genicular arteries should be catheterized and embolized upon detection of a hypervascular blush (9[7-10]; 76% ≥ 7). No evidence of superiority of either temporary or permanent embolic agents in terms of safety or efficacy has been demonstrated (10[8-10]; 86% ≥ 7). Structured long-term follow-up is recommended, with clinical success defined as achievement of the minimal clinically important difference or individual patient satisfaction (9[7-10]; 83% ≥ 7). Contralateral or repeat GAE may be considered for bilateral knee pain, insufficient response or pain recurrence (8[7-10]; 76% ≥ 7). CONCLUSION: This Delphi study establishes expert-derived consensus recommendations for GAE, emphasizing broad indications, patient-tailored technique and an active role of the IR in multidisciplinary longitudinal care.
Authors: A. Taheri Amin, J. Golzarian, K. Abd El Tawab, L. Abu-Gharbieh, O. Ahmed, A. Assis, S. A. Astani, CA. Binkert, Francisco Cesar Carnevale, F. Cavalheiro, F. Collettini, M. P. Correa, A. Dablan, K. Damodharan, Y. Epelboym, A. M. Fernández, D. Filippiadis, G. S. Goh, A. Guermazi, Z. Haskal, A. M. Ierardi, M. Katoh, M. Little, Y. Okuno, S. Padia, N. Rostambeigi, M. Sapoval, B. Taslakian, R. Uberoi, H. Vieweg, F. Ziayee, P. Minko
Institutions: Humboldt-Universität zu Berlin, Düsseldorf University Hospital, Charité - Universitätsmedizin Berlin, University of Minnesota, Ain Shams University, Ain Shams University Hospital, University of Utah, Universidade de São Paulo, Unidade Local de Saúde Gaia/Espinho, CUF Porto Hospital, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Universidade de Passo Fundo, Atitus Educação, İstanbul Başakşehir Çam ve Sakura Şehir Hastanesi, Madras Institute of Orthopaedics and Traumatology, Brigham and Women's Hospital, Hospital Universitario de León, National and Kapodistrian University of Athens, University General Hospital Attikon, The Alfred Hospital, Alfred Health, Boston University, Monash University, VA Boston Healthcare System, University of Virginia Medical Center, University of Virginia, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Helios Klinikum Krefeld, Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, University of Reading, University of California, Los Angeles, Washington University in St. Louis, Hôpital Européen Georges-Pompidou, NYU Langone Health, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Universität Hamburg, Asklepios, Asklepios Kliniken Hamburg
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,490
OpenAlex ID: W7170078437