Thermal Radiofrequency Ablation of Deep Peroneal Articular Branches for Refractory Ankle Osteoarthritis

November 6, 2026 Rachel Kim – Technology Editor Technology

Selective Thermal Ablation Treats Refractory Ankle Osteoarthritis

A 72-year-old male patient suffering from refractory bilateral mechanical ankle pain found relief following selective thermal radiofrequency ablation of the deep peroneal articular branches, Cureus reported. The procedure targeted persistent anterior joint pain rated at 7/10 on the numeric pain rating scale, dropping the score to 3/10 twelve months post-treatment without triggering motor deficits.

The Tech TL;DR:

Ultrasound clip obtained during thermal radiofrequency ablation targeting the articular branches of the right deep peroneal nerve
  • Selective thermal radiofrequency ablation successfully reduced refractory anterior ankle osteoarthritis pain from 7/10 down to 3/10 over a 12-month follow-up window.
  • A preliminary diagnostic nerve block using lidocaine and ropivacaine confirmed the exact neural pathway before the thermal procedure was initiated.
  • Motor stimulation testing at 50 Hz ensured that motor fibers remained uncompromised while targeting sensory branches near the anterior tibial artery.

Diagnostic Nerve Blocks Prior to Ablation

Initial physical evaluations conducted in May 2022 documented bilateral ankle pain predominantly affecting the right side, with strength of ankle dorsiflexion graded 5/5 on the Medical Research Council scale. Radiographs confirmed Kellgren-Lawrence grade 3 changes in the right ankle, characterized by joint-space narrowing, subchondral sclerosis, and marginal osteophytes. Early interventions, including a supervised rehabilitation program and a tibiotalar intra-articular injection of hyaluronic acid and methylprednisolone, yielded only temporary or partial relief.

To address recurring pain that returned to 7/10 following multiple rounds of pulsed radiofrequency delivered at 42 °C for six minutes per site, clinicians pursued an anatomical mapping strategy. A diagnostic nerve block administered with 2 mL of 2% lidocaine and 3 mL of 0.2% ropivacaine around the deep peroneal nerve achieved complete pain relief during walking and weight-bearing dorsiflexion. This verified that the articular branches driving the nociceptive signals resided within the anterior capsule targeted by the block.

Clinicians Perform Thermal Radiofrequency Ablation Using Dual Imaging Guidance

Following the positive diagnostic block, thermal radiofrequency ablation was performed using a 22-gauge, 6-cm radiofrequency cannula featuring a 10-mm active tip connected to a G4 generator. The clinical team utilized dual imaging guidance to execute the intervention safely. Ultrasound imaging mapped the deep peroneal nerve and the adjacent anterior tibial artery, allowing the cannula to be advanced in-plane along the anterior cortex of the distal tibia, deep to the neurovascular bundle.

Fluoroscopy subsequently verified the cannula position relative to the distal tibial articular margin, orienting the active tip horizontally to maximize the area of capsular denervation across both medial and lateral bony landmarks. Before delivering the thermal lesion, sensory stimulation at 50 Hz elicited concordant paresthesia, while motor stimulation confirmed the absence of motor fiber recruitment. At the 12-month mark, the patient maintained a lower pain score of 3/10, though localized discomfort persisted during prolonged standing and uphill walking due to a prominent anterior osteophyte.

Worth a look