No surgery needed: GAE procedure targets knee blood vessels, helps 80% of patients

Berlin: For millions of people suffering with knee pain, a new non-surgical procedure offers the promise of easing it for at least 12 months with a single injection.

Genicular artery embolization, or GAE, is an emerging, minimally invasive treatment that targets abnormal blood vessels in osteoarthritis patients. In an osteoarthritic knee, abnormal vessels build up around the joint and drive inflammation and pain. During GAE, a radiologist guides a thin catheter to each affected vessel and injects tiny particles to block it, calming inflammation and easing pain without surgery.

The injection uses rapidly resorbable, gelatin-based microspheres designed to dissolve within hours. “For the right patient, it can mean lasting relief from a single, minimally invasive procedure — a meaningful new option between injections and joint replacement,” said Dr. Florian Fleckenstein, who led a major trial into GAE from his research hub in Berlin, Germany.“

By reducing both inflammation and pain, GAE with resorbable microspheres may be the first procedure that alters the course of the disease, slowing its progression.”Osteoarthritis is the most common form of arthritis and causes inflammation, stiffness, reduced mobility, and nerve pain. Knee osteoarthritis affects more than 365 million adults worldwide and is one of the leading contributors to disability, according to the World Health Organization.

“For many patients with knee osteoarthritis, there is a real treatment gap today,” Dr. Fleckenstein said. “For many patients joint replacement is not an option for medical or personal reasons.”The study included 114 women and 80 men with an average age of 69. All had osteoarthritis-related knee pain and did not respond to at least 3 months of regular treatment, including physiotherapy, anti-inflammatory drugs, and intra-articular injections. All participants underwent GAE with resorbable microspheres between July and November 2024. Around 1 in 4, or 23%, had bilateral knee osteoarthritis and received 2 GAE procedures within 4 weeks. In total, patients underwent 239 GAE procedures.

All procedures were technically successful with no moderate or severe adverse events. Only mild, self-limited reactions occurred in 6.7% of the study group. A six-month follow-up was performed in person by an orthopedic surgeon.

Pain scores fell quickly and kept improving, according to findings published in the journal Radiology. At the 12-month follow-up, 80% of participants achieved improvements exceeding the minimum clinically important difference. Patients also reported a significant increase in function, including sports, recreation, and daily activity.

“Our study demonstrates that GAE using rapidly resorbable gelatin-based microspheres is a safe, minimally invasive therapy that provides meaningful pain relief and functional improvement for at least 12 months,” Dr. Fleckenstein said. “With almost 200 patients, this is the largest body of evidence yet for GAE using rapidly resorbable microspheres — this lets us speak about safety and efficacy with real confidence.”