{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:17:28Z","timestamp":1790036248900,"version":"4.0.1"},"reference-count":48,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Genicular artery embolization (GAE) has emerged as a minimally invasive interventional radiology technique for the management of symptomatic knee osteoarthritis (OA), a highly prevalent condition associated with substantial functional impairment and socioeconomic burden. The rationale of GAE is based on superselective embolization of pathological periarticular neovascularization, aiming to modulate synovial inflammation, angiogenesis, and nociceptive signaling while preserving physiological joint perfusion. This narrative review provides an interventional radiology\u2013oriented framework integrating pathophysiological mechanisms, imaging-based patient selection, and procedural strategy. Particular emphasis is placed on the vascular\u2013inflammatory phenotype of OA, MRI-derived biomarkers of synovitis and hypervascularity, and technical aspects of embolization, including embolic agent selection and angiographic endpoints. A structured literature search was performed to identify relevant studies, including prospective trials and randomized controlled studies. Available evidence is critically discussed, with attention to clinical outcomes, safety profile, and current limitations. In addition, practical technical considerations and procedural pitfalls are summarized to provide a clinically applicable perspective. GAE represents a promising therapeutic option for selected patients with knee OA refractory to conservative management. However, further high-quality studies are required to define long-term durability, optimal patient selection, and standardized procedural strategies.<\/jats:p>","DOI":"10.3390\/diagnostics16091325","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T13:26:41Z","timestamp":1777382801000},"page":"1325","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Genicular Artery Embolization for Knee Osteoarthritis: An Interventional Radiology Perspective on Pathophysiology, Imaging Biomarkers and Procedural Strategy"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9317-5472","authenticated-orcid":false,"given":"Alberto","family":"Rebonato","sequence":"first","affiliation":[{"name":"Radiology Department, San Salvatore Hospital, 61121 Pesaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Ruschioni","sequence":"additional","affiliation":[{"name":"Radiology Department, San Salvatore Hospital, 61121 Pesaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Mancini","sequence":"additional","affiliation":[{"name":"Radiology Department, San Salvatore Hospital, 61121 Pesaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Mulazzani","sequence":"additional","affiliation":[{"name":"Radiology Department, San Salvatore Hospital, 61121 Pesaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4838-3011","authenticated-orcid":false,"given":"Eva","family":"Fraternali","sequence":"additional","affiliation":[{"name":"Orthopedic Department, San Salvatore Hospital, 61121 Pesaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Baldini","sequence":"additional","affiliation":[{"name":"Orthopedic Department, San Salvatore Hospital, 61121 Pesaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicol\u00f2","family":"Baiocchi","sequence":"additional","affiliation":[{"name":"Department of Translation Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4421-7941","authenticated-orcid":false,"given":"Daniele","family":"Maiettini","sequence":"additional","affiliation":[{"name":"Division of Interventional Radiology, European Institute of Oncology, 20141 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4630-1090","authenticated-orcid":false,"given":"Corrado","family":"Tagliati","sequence":"additional","affiliation":[{"name":"Ospedale di Comunit\u00e0 Maria Montessori di Chiaravalle, AST Ancona, 60033 Chiaravalle, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Mem\u00e8","sequence":"additional","affiliation":[{"name":"Orthopedic Department, San Salvatore Hospital, 61121 Pesaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"ref_1","unstructured":"GBD 2019 Diseases and Injuries Collaborators (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet, 396, 1204\u20131222."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/S0140-6736(19)30310-1","article-title":"The global syndemic of obesity, undernutrition, and climate change","volume":"393","author":"Mendenhall","year":"2019","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1136\/annrheumdis-2013-204763","article-title":"The global burden of hip and knee osteoarthritis: Estimates from the global burden of disease 2010 study","volume":"73","author":"Cross","year":"2014","journal-title":"Ann. Rheum. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"780","DOI":"10.2106\/00004623-200704000-00012","article-title":"Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030","volume":"89","author":"Kurtz","year":"2007","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1007\/s00223-014-9917-9","article-title":"Osteoarthritis pathogenesis: A review of molecular mechanisms","volume":"95","author":"Xia","year":"2014","journal-title":"Calcif. Tissue Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.joca.2014.12.022","article-title":"Future projections of total hip and knee arthroplasty in the UK: Results from the UK Clinical Practice Research Datalink","volume":"23","author":"Culliford","year":"2015","journal-title":"Osteoarthr. Cartil."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Brown, J.M., Vandeveer, Z.T., Cadoret, D., Morrison, J.J., and Jahangiri, Y. (2025). Genicular artery embolization: Anatomy, pathophysiology, current evidence and future directions. J. Clin. Med., 14.","DOI":"10.20944\/preprints202502.1314.v1"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.jvir.2012.11.011","article-title":"Geniculate artery embolization in the management of spontaneous recurrent hemarthrosis of the knee: Case series","volume":"24","author":"Bagla","year":"2013","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/j.arth.2017.11.002","article-title":"Embolization of the Geniculate Arteries Is an Effective Treatment of Recurrent Hemarthrosis Following Total Knee Arthroplasty That Can Be Safely Repeated","volume":"33","author":"Hoogeveen","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1007\/s00270-014-0944-8","article-title":"Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis","volume":"38","author":"Okuno","year":"2015","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1016\/j.jvir.2017.02.033","article-title":"Midterm Clinical Outcomes and MR Imaging Changes after Transcatheter Arterial Embolization as a Treatment for Mild to Moderate Radiographic Knee Osteoarthritis Resistant to Conservative Treatment","volume":"28","author":"Okuno","year":"2017","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1016\/j.jvir.2019.09.018","article-title":"Genicular Artery Embolization for the Treatment of Knee Pain Secondary to Osteoarthritis","volume":"31","author":"Bagla","year":"2020","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1055\/s-0041-1736530","article-title":"A Review of Musculoskeletal Embolization to Treat Pain Outside of the Knee","volume":"38","author":"Sajan","year":"2021","journal-title":"Semin. Interv. Radiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2309","DOI":"10.1007\/s00256-022-04208-0","article-title":"Genicular artery embolization as a treatment for refractory osteoarthritis related knee pain","volume":"52","author":"Epelboym","year":"2023","journal-title":"Skelet. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100878","DOI":"10.1016\/j.tvir.2022.100878","article-title":"Genicular Artery Embolization Technique","volume":"26","author":"Sterbis","year":"2023","journal-title":"Tech. Vasc. Interv. Radiol."},{"key":"ref_16","first-page":"592","article-title":"Embolization of genicular arteries in patients with knee osteoarthritis as an alternative for refractory pain treatment: A systematic review","volume":"159","year":"2022","journal-title":"Med. Clin."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.1016\/j.jvir.2023.07.009","article-title":"Evaluating the Safety and Effectiveness of Quick-Soluble Gelatin Sponge Particles for Genicular Artery Embolization for Chronic Knee Pain Associated with Osteoarthritis","volume":"34","author":"Min","year":"2023","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"111443","DOI":"10.1016\/j.ejrad.2024.111443","article-title":"Genicular artery embolization for the treatment of knee pain secondary to mild to severe knee osteoarthritis: One year clinical outcomes","volume":"175","author":"Sun","year":"2024","journal-title":"Eur. J. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/j.jvir.2021.02.006","article-title":"Embolic Characteristics of Imipenem-Cilastatin Particles In Vitro and In Vivo: Implications for Transarterial Embolization in Joint Arthropathies","volume":"32","author":"Yamada","year":"2021","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1186\/2193-1801-2-344","article-title":"Imipenem\/cilastatin sodium (IPM\/CS) as an embolic agent for transcatheter arterial embolisation: A preliminary clinical study of gastrointestinal bleeding from neoplasms","volume":"2","author":"Woodhams","year":"2013","journal-title":"Springerplus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1055\/s-0044-1788029","article-title":"Genicular Artery Embolization: Embolic Material and Imaging Review","volume":"41","author":"Rouzbahani","year":"2024","journal-title":"Semin. Interv. Radiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1016\/j.jvir.2025.02.031","article-title":"Comparative Safety of 3 Temporary Embolic Agents in Transcatheter Arterial Embolization for Degenerative, Inflammatory, and Overuse Joint Disorders","volume":"36","author":"Kubo","year":"2025","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Padia, S.A., Genshaft, S., Blumstein, G., Plotnik, A., Kim, G.H.J., Gilbert, S.J., Lauko, K., and Stavrakis, A.I. (2021). Genicular Artery Embolization for the Treatment of Symptomatic Knee Osteoarthritis. JBJS Open Access, 6.","DOI":"10.2106\/JBJS.OA.21.00085"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"919.e1","DOI":"10.1016\/j.jvir.2021.03.409","article-title":"Percutaneous Management of Osteoarthritis in the Knee: Proceedings from the Society of Interventional Radiology Research Consensus Panel","volume":"32","author":"Ahmed","year":"2021","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1093\/rheumatology\/keh344","article-title":"Osteoarthritis, angiogenesis and inflammation","volume":"44","author":"Bonnet","year":"2005","journal-title":"Rheumatology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.1093\/rheumatology\/keq188","article-title":"Angiogenesis and nerve growth factor at the osteochondral junction in rheumatoid arthritis and osteoarthritis","volume":"49","author":"Walsh","year":"2010","journal-title":"Rheumatology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1097\/BOR.0b013e328349c2b1","article-title":"Inflammation in osteoarthritis","volume":"23","author":"Goldring","year":"2011","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1016\/j.joca.2024.07.014","article-title":"Osteoarthritis year in review 2024: Epidemiology and therapy","volume":"32","author":"Courties","year":"2024","journal-title":"Osteoarthr. Cartil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"102459","DOI":"10.1016\/j.gaceta.2025.102459","article-title":"Genicular artery embolization for knee osteoarthritis: A systematic review with meta-analysis and cost-analysis","volume":"39","year":"2025","journal-title":"Gac. Sanit."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1007\/s00270-024-03752-7","article-title":"Genicular Artery embolisation in Patients with Osteoarthritis of the Knee (GENESIS) Using Permanent Microspheres: Long-Term Results","volume":"47","author":"Little","year":"2024","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Fukui, N., Yamane, S., Ishida, S., Tanaka, K., Masuda, R., Tanaka, N., Katsuragawa, Y., and Fukui, S. (2010). Relationship between radiographic changes and symptoms or physical examination findings in subjects with symptomatic medial knee osteoarthritis: A three-year prospective study. BMC Musculoskelet. Disord., 11.","DOI":"10.1186\/1471-2474-11-269"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e243648","DOI":"10.1148\/radiol.243648","article-title":"Genicular Artery Embolization for the Treatment of Symptomatic Knee Osteoarthritis","volume":"316","author":"Fleckenstein","year":"2025","journal-title":"Radiology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"23259671211021356","DOI":"10.1177\/23259671211021356","article-title":"Osteoarthritis-Related Knee Pain Treated with Genicular Artery Embolization: A Systematic Review and Meta-analysis","volume":"9","author":"Torkian","year":"2021","journal-title":"Orthop. J. Sports Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00270-020-02687-z","article-title":"Genicular Artery Embolization for Osteoarthritis Related Knee Pain: A Systematic Review and Qualitative Analysis of Clinical Outcomes","volume":"44","author":"Casadaban","year":"2021","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1016\/j.jvir.2024.08.028","article-title":"Genicular Artery Embolization for Treatment of Symptomatic Knee Osteoarthritis: 2-Year Outcomes from a Prospective IDE Trial","volume":"35","author":"Cusumano","year":"2024","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"7617","DOI":"10.1007\/s00330-025-11702-1","article-title":"Early intervention in knee osteoarthritis with genicular artery embolization is associated with improved clinical outcomes","volume":"35","author":"Callese","year":"2025","journal-title":"Eur. Radiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1007\/s00270-020-02764-3","article-title":"Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis","volume":"44","author":"Little","year":"2021","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1002\/art.41142","article-title":"2019 American College of Rheumatology\/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee","volume":"72","author":"Kolasinski","year":"2020","journal-title":"Arthritis Rheumatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1007\/s00270-019-02289-4","article-title":"Clinical outcomes of transcatheter arterial embolisation for chronic knee pain: Mild-to-moderate versus severe knee osteoarthritis","volume":"42","author":"Lee","year":"2019","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.jvir.2021.09.019","article-title":"Multicenter Randomized Sham Controlled Study of Genicular Artery Embolization for Knee Pain Secondary to Osteoarthritis","volume":"33","author":"Bagla","year":"2022","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.joca.2003.11.003","article-title":"Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis","volume":"12","author":"Peterfy","year":"2004","journal-title":"Osteoarthr. Cartil."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1016\/j.jvir.2024.06.003","article-title":"Effectiveness of Genicular Artery Embolization for Reducing Synovitis as Assessed by Contrast-Enhanced MR Imaging in Knee Osteoarthritis: A Pilot Study","volume":"35","author":"Dablan","year":"2024","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1007\/s00270-025-04188-3","article-title":"Genicular Artery Embolization for Symptomatic Knee Osteoarthritis: A Comprehensive Review of Techniques and Clinical Outcomes","volume":"48","author":"Ahmed","year":"2025","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.jor.2025.07.022","article-title":"Genicular artery embolization for knee osteoarthritis: A systematic review of sham-controlled randomized trials","volume":"67","author":"Milhem","year":"2025","journal-title":"J. Orthop."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Bedson, J., and Croft, P.R. (2008). The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature. BMC Musculoskelet. Disord., 9.","DOI":"10.1186\/1471-2474-9-116"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.rdc.2012.10.003","article-title":"Imaging of osteoarthritis","volume":"39","author":"Guermazi","year":"2013","journal-title":"Rheum. Dis. Clin. N. Am."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1007\/s00270-021-02978-z","article-title":"Cadaveric and Angiographic Anatomical Considerations in the Genicular Arterial System: Implications for Genicular Artery Embolisation in Patients with Knee Osteoarthritis","volume":"45","author":"Welsh","year":"2022","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1007\/s00270-025-04274-6","article-title":"Genicular Artery Embolization Using Resorbable Gelatin Microspheres for Refractory Knee Pain: Technique, Safety and Clinical Outcome","volume":"49","author":"Amin","year":"2026","journal-title":"Cardiovasc. Interv. Radiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1325\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T04:11:49Z","timestamp":1778386309000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1325"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":48,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16091325"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16091325","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]}}}