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Genicular Artery Embolization — Knee

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🦵 Knee osteoarthritis — Innovative technique

Genicular Artery Embolization — Knee Osteoarthritis

No surgery · Day case · Local anaesthesia · Targets the source of inflammation
Medical encyclopedia · Cochin AP-HP

Genicular artery embolization: synovial neovessels and mechanism of action

Understanding the pathophysiological rationale of genicular embolization for chronic knee osteoarthritis pain

Cochin Hospital AP-HP · Pr Anthony Dohan · Updated October 2026
Synovial neoangiogenesis: the key to the mechanism
In knee osteoarthritis, the diseased synovium develops abnormal new blood vessels (neoangiogenesis) accompanied by pain-sensing nerve fibres. These neovessels are not present in a normal knee. Embolization selectively targets these pathological neovessels through the genicular arteries, without affecting the normal vessels of the knee.

Quick answer

Chronic pain in knee osteoarthritis is not only due to cartilage destruction: it is largely linked to synovial inflammation sustained by pathological neovascularization. Embolization precisely targets these abnormal neovessels to reduce pain.

Pathophysiology of pain in knee osteoarthritis

Chronic pain in knee osteoarthritis is not only due to cartilage destruction. It is largely mediated by chronic synovial inflammation sustained by pathological neovascularization (neoangiogenesis). The synovial neovessels are accompanied by sensory nerve fibres (nerve co-neovascularization), which amplify pain signals.

This mechanism, well documented in other conditions (frozen shoulder, tennis elbow), has been applied to the knee by several teams, including the Cochin AP-HP team.

Genicular artery embolization (GAE) technique

Genicular artery embolization (GAE) targets the small genicular arterial branches that supply the diseased synovium:

  • Superior medial genicular artery
  • Inferior medial genicular artery
  • Inferior lateral genicular artery
  • Other genicular branches of the knee, depending on individual anatomy

Calibrated microspheres (75-150 or 100-300 microns) are injected selectively into these arterial branches to block the pathological neovascularization, without compromising the blood supply of the cartilage, ligaments or menisci.

Frequently asked questions

Does knee embolization destroy cartilage?
No. Knee articular cartilage is avascular (it has no blood vessels of its own). Embolization targets only the neovessels of the diseased synovium and does not affect the cartilage.
How long does the effect of knee embolization last?
In published series, pain relief is seen in 75-85% of cases at 3 months and persists at 1-2 years in most responders. Retreatment is possible if needed.
Is knee embolization compatible with a later knee replacement?
Yes. Embolization involves no anatomical destruction and does not rule out a later total knee replacement. Some surgeons offer it precisely as a bridging treatment while waiting for surgery.
Learn more
Genicular artery embolization at Cochin

Indications, full technique and results of genicular embolization.

See the full page

Scientific references

Genicular artery embolization for knee osteoarthritis: results of the LipioJoint-1 trial

Sapoval M, Querub C, Pereira H, Pellerin O, Boeken T, Di Gaeta A, et al. Diagn Interv Imaging 2024;105(4):144-150.

Society of Interventional Radiology Research Reporting Standards for Genicular Artery Embolization

J Vasc Interv Radiol 2024.

New: 2026 review on musculoskeletal embolization

A narrative review published in October 2026 in CVIR Endovascular (Pelage JP, Aldalmani T, Geevarghese R, Zhang N, Jegonday MA, Berry G, Dohan A, Fohlen A, Grange S) classifies the indications of musculoskeletal arterial embolization by level of evidence. Hemostatic indications and some tumour indications are established. Embolization for pain, including genicular embolization and embolization of tendinopathies, is performed as a stand-alone minimally invasive procedure targeting pathological neovascularization. Data remain heterogeneous: the authors stress patient selection, standardized outcome assessment and new comparative trials to clarify durability and clinical value. The review cites genicular artery embolization in knee osteoarthritis, the subject of this page.

Read the review (DOI) → · View on PubMed →

Why this page is trustworthy

Written by the Interventional Radiology team of Cochin Hospital AP-HP, Université Paris Cité. Medical review by an interventional radiologist of the department. Last updated: October 2026.

Related pages

New in the literature: 2026 review of musculoskeletal embolization

A narrative review published in October 2026 in CVIR Endovascular (Pelage JP, Aldalmani T, Geevarghese R, Zhang N, Jegonday MA, Berry G, Dohan A, Fohlen A, Grange S) sorts the indications of musculoskeletal arterial embolization by level of evidence. Hemostatic and selected tumour-related indications are established. Pain-directed embolization, including genicular artery embolization and embolization for tendinopathies, is performed as a stand-alone minimally invasive procedure targeting pathological neovascularity. Evidence remains heterogeneous: the authors stress careful patient selection, standardized outcome assessment and further comparative trials to define durability and clinical value. It covers genicular artery embolization for knee osteoarthritis, the subject of this page.

Read the review (DOI) → · View on PubMed →

Why this page is trustworthy

Written by the Interventional Radiology team at Cochin Hospital AP-HP, Université Paris Cité. Medically reviewed by an interventional radiologist of the department. Last updated: August 2026.

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