Accuracy comparisons of intra-articular knee injection between the new modified anterolateral Approach and superolateral approach in patients with symptomatic knee osteoarthritis without effusion

Abstract

Background Intra-articular knee injection with steroid or various other agents have been used to control the local inflammation and relieve pain in the osteoarthritis knee. To achieve the maximal potential therapeutic worth and decrease the complications from the inaccurate knee injection, these medications should be delivered directly into the intra-articular space. Injection technique is one of the most important factors for accuracy of knee injection. Therefore, this study was aimed to propose the new modified anterolateral injection technique for higher accuracy of knee injection in symptomatic osteoarthritis knee without effusion. Material and methods Patients with symptomatic osteoarthritis without effusion were included prospectively from May 2014 to May 2015 and randomized into 2 groups for knee injection: Modified anterolateral (MAL), Standard superolateral (SL). Knee injection was performed by one experienced orthopaedic. Accuracy of injection was test by mini air-arthrography technique. The pain from injection were evaluated by visual analog scale (VAS). Result 132 knees were included, 66 knees were modified anterolateral group same as superolateral group. The modified anterolateral injection was significantly yield the higher accuracy rate than the standard superolateral injection (89% vs 58%, P < 0.05). The pain visual analog scale was not significantly different between the modified anterolateral and standard superolateral injection technique (2.61 vs 2.65, P = 0.917) No adverse events were occurred. Conclusion The new modified anterolateral injection yields the higher pooled accuracy rate. From the accuracy and the advantage of the new modified anterolateral injection, this is the preferred injection technique for the symptomatic osteoarthritis without knee effusion.

Ultrasound-Guided Knee Injections Are More Accurate Than Blind Injections: A Systematic Review of Randomized Controlled Trials

“…The majority of Level I studies gathered in this review (8/12) 14-21 compared the accuracy of ultrasound-guided versus blind or landmark injection/arthrocentesis. Only 4 of 12 studies 22 , 23 , 24 , 25 compared the accuracy of anatomical-guided approaches. The majority of studies recruited patients with radiographically confirmed knee osteoarthritis (9/12 studies).…”

“…Cunnington et al 21 used an inexperienced rheumatology trainee for all ultrasound-guided injections and still had relatively high accuracy rates, 91% (32/35), compared with clinical examinationeguided IAKI performed by rheumatology consultants (median 15 years' experience), 82% (27/33). Interestingly in the anatomical accuracy comparison chart in Table 5, Chernchujit et al 24 reported that the accuracy for blind IAKI to superolateral approach only was 58% (38/66).…”

“…Wind et al 25 reported that their injection accuracy through the superomedial approach was also high at 93% (40/43). The modified anteromedial approach was used by 2 studies, Toda 25 1 e e e 1 2 e6 et al 22 and Chernchujit et al, 24 and had an accuracy rate of 86% (43/50) and 89% (59/66), respectively. In a single study looking at the superolateral approach, Chernchujit et al reported the accuracy only being 58% (38/66).…”

“…The procedural methods used in these knee injection studies also varied: 5 studies injected hyaluronic acid, 14,15,20,22 23 3 studies injected corticosteroid followed by a contrast agent, 14,17,21 and 2 studies performed arthrocentesis. 18,19 One study injected air and medical agents, 24 and 1 study injected methylene blue dye directly into the joint. 25 The differences in injected agents could lead to variability in detection, potentially confounding accuracy.…”

A Vibration Sensor Approach to Detect Intra-Articular Needle Tip Placement in the Knee Joint

“…However, in 90 o -bended knee position, a study using squishing technique [12] and post-injection mini airarthrography [13] showed higher accuracy (89%) of modi ed anterolateral approach compared to superolateral approach (58%) [14].…”