Ultrasound-guided Knee Interventions for Pain Management: Techniques, Evidence, and Clinical Applications—A Narrative Review

Background: Knee pain is a leading cause of disability worldwide, with ultrasound-guided (USG) interventions increasingly utilized to improve procedural accuracy and clinical outcomes. Compared with landmark-based techniques, ultrasound allows real-time visualization of target structures and surrounding anatomy, potentially enhancing safety and efficacy. However, variability in techniques, injectates, and levels of evidence necessitates a consolidated clinical overview. Materials and Methods: This narrative review synthesizes available evidence on USG-guided knee interventions for pain management. Literature was searched across major databases from inception and updated at the time of manuscript submission. Evidence relating to sonoanatomy, intra-articular and periarticular injections, genicular nerve interventions, biologic therapies, procedural accuracy, and comparative outcomes was qualitatively reviewed. Results: USG guidance consistently demonstrated superior accuracy and reduced procedural pain compared with landmark-guided techniques, particularly for intra-articular injections, arthrocentesis, and genicular nerve blocks. Among injectates, corticosteroids provided short-term symptom relief, while platelet-rich plasma (PRP) showed more sustained benefits in mild-to-moderate knee osteoarthritis. Recent comparative evidence, including meta-analytic data, indicates no consistent clinical superiority of bone marrow aspirate concentrate over PRP despite greater invasiveness and cost. Genicular nerve-based interventions offered meaningful analgesia in refractory knee pain. Conclusion: USG knee interventions represent a safe, accurate, and versatile approach in pain management. Current evidence supports a stepwise, patient-centered strategy favoring USG PRP in appropriate candidates, with nerve-targeted procedures reserved for refractory pain states.