###### Abstract  
Radiofrequency (RF) is a mini-invasive neuromodulation intervention that is commonly used in chronic pain conditions including general musculoskeletal pain related to several diseases, including knee osteoarthritis (KOA). However, to date, few studies investigated synergistic therapeutic approaches combining RF with rehabilitative physical exercise protocols in KOA patients. This prospective cohort study aimed at assessing the short-term effects on pain in KOA patients of a multimodal intervention consisting of ultrasound (US)-guided RF geniculate ablation and concomitant rehabilitative physical exercise. We included grade III KOA patients with knee pain (Numerical Pain Rating Scale, NPRS >4) not responsive to conventional treatments. They underwent a combined intervention including US-guided RF geniculate ablation and a 2-week physical exercise program. At the baseline (T0) and 1 month after (T1) we assessed: NPRS, Knee Injury and Osteoarthritis Outcome Scale (KOOS), quality of life, exercise adherence, and safety. All the 47 KOA patients enrolled (68.8 \(\pm\) 13.7 years old) showed a reduction of pain (NPRS: 7.48 \(\pm\) 1.74; 3.63 \(\pm\) 1.68; \(p\) < 0.001). In addition, there was a significant improvement (\(p\) < 0.05) also in the other functioning and HRQoL outcomes. Adherence to the exercise program was over 80% in more than half (28) of the patients. No major adverse events were reported. These findings suggested that US-guided RF ablation of genicular nerves combined with rehabilitative exercise therapy might be considered a safe and effective approach in the complex management of KOA patients. osteoarthritis; osteoarthritis; knee; radiofrequency ablation; pain; disability evaluation +
Footnote †: journal: Medical and Surgical Sciences, University of Catanzaro \"Magna Graecia\", 88100 Catanzaro, Italy; [EMAIL_ADDRESS]  
Footnote †: journal: Medical and Surgical Sciences, University of Catanzaro \"Magna Graecia\", 8810 Catanzaro, Italy; [EMAIL_ADDRESS]  
Footnote †: journal: Medical and Surgical Sciences, University of Catanzaro \"Magna Graecia\", 88100 Catanzaro, Italy; [EMAIL_ADDRESS]  
Footnote †: journal: Medical and Surgical Sciences, University of Catanzaro \"Magna Graecia\", 8810 Catanzaro, Italy; [EMAIL_ADDRESS]  
Footnote †: journal: Medical and Surgical Sciences, University of Catanzaro \"Magna Graecia\", 88100 Catanzaro, Italy; ammendola@unic. Non-surgical treatments of symptomatic knee OA include rehabilitation interventions and pharmacological treatments, such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids [7; 8; 9]. However, intra-articular injections with hyaluronic acid and glucocorticoids have been demonstrated to have a role in pain relief and recovering the viscoelastic properties of the synovial fluid and might be considered as a second-line approach in patients not responsive to acetaminophen and/or NSAIDs [7; 10]. Furthermore, in recent years, there has been an increasing interest in other non-pharmacological treatments of KOA patients, including focal vibration [11], IA oxygenase (O2O3) therapy [12; 13; 14; 15], and radiofrequency (RF) ablation of genicular nerves [16; 17; 18]. This technique targets specific nerves producing a thermal lesion to the afferent sensitive nerve that interrupts nociceptive signals [19] and takes advantage of physical energy to treat chronic pain unresponsive to conservative therapies [20]. Thus, RF is considered a safe technique for patients with several comorbidities suffering critical painful conditions (e.g., trigeminal neuralgia, cancer pain, and spinal pain) [20], and has been recently proposed to treat severe KOA in patients not responsive to conservative management or not candidates for surgery [16; 17; 18]. Previous studies investigated the efficacy of percutaneous fluoroscopic-guided RF ablation performed on genicular nerves with promising results on pain and physical function [16; 17].