Anterior approach for knee arthrography

Abstract

All the arthrograms were technically successful. The anterior approach to knee MRA has greater technical ease than the traditional approach with little patient discomfort.

Aspiration and Injection of the Knee Joint: Approach Portal

“…Aspiration or injection via the LMP or MMP approaches has been reported to be uncomfortable for patients, and can be painful if access is difficult. These approaches can be difficult when patients tense the thigh extensors; in the obese; and in patients with patellofemoral arthrosis12). Wind and Smolinski13) have suggested that, as lateral joint line injections (ie LMP) may not be reliable for routine injections of low volumes of fluid into the knee joint as it results in good IA delivery less than half the time with a high incidence of soft-tissue infiltration, a superomedial or superolateral approach should be used instead.…”

“…Shortt et al4) reported that only 7/64 (11%) of surveyed North American musculoskeletal radiologists preferentially utilised an arthroscopic approach for injection of the knee joint. Anterior techniques utilise an entry approach analogous to the portals used for knee arthroscopy12,21). These approaches are useful when the knee cannot be extended, or when there is only a minimal amount of fluid in the knee joint14).…”

“…These approaches traverse only Hoffa's fat pad and they avoid the extensor mechanism and major blood vessels. With correct technique, the anterior horns of the menisci and the transverse patellar ligaments are easily avoided12,21). Jackson et al11) examined the accuracy of knee joint injection by a single orthopaedic surgeon using these approach portals.…”

“…They determined that the anterolateral approach was the most accurate (85%) but that this was not statistically significant compared to the anteromedial (73%) and LMP (76%) approaches. It is reported that the arthroscopic approaches involve little pain or discomfort12). The major problem with these approaches has been reported to be difficulty in obtaining fluid from an affected joint14).…”

Sonographic diagnosis of an arterioarticular fistula following knee arthrocentesis

“…Although the anteromedial approach 2,6 has been widely used, Jackson et al 2 found the lateral approach more successful in a series of 240 knee injections in patients with no clinical knee joint effusion. In addition, Roberts et al 7 found that the medial plica and a medial patella fat pad could cause difficulty with an intra-articular needle.…”