Anterolateral Portal Is Less Painful than Superolateral Portal in Knee Intra-Articular Injection

Lee, Sung Yup; Gn, Kiran Kumar; Chung, Byung June; Lee, Sang Wook; Kim, Tae Kyun

doi:10.5792/ksrr.2015.27.4.228

Cited by 11 publications

(10 citation statements)

References 15 publications

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“…An increase in BMI seems to be a predictor of pain in anterolateral access. Our pain VAS results are partially in contrast with previous findings: Chavez-Chiang et al [ 10 ] reported a mean VAS pain score of 4.8 for anterolateral access, while Lee et al [ 11 ] found that the anterolateral approach is less painful than superolateral. We could hypothesize that such differences might be related to the use of a thinner 21-gauge needle than Lee’s cohort [ 11 ]; moreover, operator expertise and grade of local joint inflammation may be taken into account in order to explain the different outcomes.…”

Section: Discussioncontrasting

confidence: 99%

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Difference in pain and accuracy of two hyaluronic acid injection techniques for symptomatic knee osteoarthritis in overweight patients

et al. 2021

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Objectives To evaluate differences of injection related pain, and the accuracy of the techniques in two groups of overweight patients, performing the anterolateral approach for one group (G1) and the superolateral approach for the second group (G2). Material and methods In the study, 126 knee joints from 86 osteoarthritis (OA) patients were evaluated. Inclusion criteria were body mass index (BMI) ≥ 25, absence of effusion and coagulopathy. Pain evaluation during injection was evaluated with Visual Analogue Scale (VAS), while accuracy of the procedure was evaluated with ultrasound (US). Results The patients’ mean age was 69.9 ±9.01, VAS for G1 group was 1.71 ±1.89, for G2 group was 1.74 ±1.31. Mean BMI was 29.69 ±2.86, for G1 group was 28.29 ±3.29, for G2 group was 30.32 ±2.41. No adverse events (AE) occurred in both studied groups. The accuracy rate of the procedure was 69.1% for G1 (38/55 knees), 95.7% for G2 (68/71 knees). No significant difference was found in VAS pain score between G1 and G2 group ( p = 0.45). We found the significant correlation between BMI and VAS pain score in anterolateral accesses (G1) ( r = 0.51; p < 0.005). No correlation was found between age and VAS pain score in anterolateral access (G1). For the superolateral access (G2), no correlation was found for age or BMI and VAS pain score. Conclusions Hyaluronic acid injection is safe therapeutic option for knee OA with no significant differences between anterolateral and superolateral approaches in terms of pain in overweight patients. However, higher BMI seems to be a predictor of pain in anterolateral access, and the superolateral approach should be preferred in this group of patients.

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Section: Discussioncontrasting

confidence: 99%

“…In clinical practice, knee injection is a very well tolerated therapeutic option. In the literature, few papers have assessed injection related pain in knee OA, with contrasting outcomes between pain difference for the two techniques [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Difference in pain and accuracy of two hyaluronic acid injection techniques for symptomatic knee osteoarthritis in overweight patients

et al. 2021

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“…[8][9][10] If this positioning results in no fluid return the needle is manipulated into the patellofemoral joint and the intracondylar notch. [1][2][3][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] However, even with this standard extended knee approach, after conventional arthrocentesis typically there is considerable residual synovial fluid remaining in the joint (approximately 30%-40%), thus, full fluid extraction using conventional arthrocentesis even in the extended positioning is incomplete. 27 Although the extended knee superolateral suprapatellar bursa approach is the traditional anatomic puncture point for arthrocentesis, there are a number of advantages to the anterolateral portal flexed knee approach for arthrocentesis and joint injection.…”

Section: Discussionmentioning

confidence: 99%

“…The anterolateral portal was defined by palpation of the adjoining structures of anterolateral border of the patella, the lateral border of the patellar tendon, and the anterolateral tibial plateau with the entry point adjacent to the lateral patellar tendon, thus avoiding the lateral geniculate artery. [12][13][14][15] The anterolateral portal was thus determined and marked with the tip of a retractable ballpoint pen with the point retracted leaving a depression in the skin. A thigh blood pressure leg cuff (HCS 9029LF, Cuff and Bladder Latex-Free, Thigh Size, Sphygmomanometer, Dyad Medical Sourcing, LLC, Bannockburn, IL, USA) was placed around the superior flexed knee where it surrounded the upper leg and the suprapatellar bursa (Figure 1).…”

Section: Arthrocentesis Techniquementioning

confidence: 99%

Enhanced arthrocentesis of the effusive knee with pneumatic compression

Brahmbhatt

Iqbal

Farshami³

et al. 2022

Int J of Rheum Dis

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Aim: Complete arthrocentesis of the effusive knee ameliorates patient pain, reduces intra-articular and intraosseous pressure, removes inflammatory cytokines, and has been shown to substantially improve the therapeutic outcomes of intra-articular injections. However, conventional arthrocentesis incompletely decompresses the knee, leaving considerable residual synovial fluid in the intra-articular space. The present study determined whether external pneumatic circumferential compression of the effusive knee permitted more successful arthrocentesis and complete joint decompression.Methods: Using a paired sample design, 50 consecutive effusive knees underwent conventional arthrocentesis and then arthrocentesis with pneumatic compression.Pneumatic compression was applied to the superior knee using a conventional thigh blood pressure cuff inflated to 100 mm Hg which compressed the suprapatellar bursa and patellofemoral joint, forcing fluid from the superior knee to the anterolateral portal where the fluid could be accessed. Arthrocentesis success and fluid yield in mL before and after pneumatic compression were determined.Results: Successful diagnostic arthrocentesis (≥3 mL) of the effusive knee was 82% (41/50) with conventional arthrocentesis and increased to 100% (50/50) with pneumatic compression (P = .001). Synovial fluid yields increased by 144% (19.8 ± 17.1 mL)

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“…Patients that met our inclusion criteria were informed about our study design and objective and after signing the informed consent they received two consecutive intraarticular injections of 24 mg/3 ml of (500-730 kDa) modified HA (Hymovis®, Fidia Farmaceutici S.p.A, Italy) at one-week interval. As the anterolateral portal proved to be less painful in intraarticular administration of treatments [18], all injections were performed in the outpatient clinic under aseptic conditions in the aforementioned location. Follow-up visits were scheduled at 6 and 12 months after the injections.…”

Section: Methodsmentioning

confidence: 99%

Changes in Knee Joint Space Width in Treatment with a New Hyaluronic-Based Hydrogel

Russu

Feier

Pop

et al. 2017

Acta Medica Marisiensis

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Objective: Our purpose was to assess the effect of a new hyaluronic acid-based (Hymovis®) injections on joint space width narrowing in patients diagnosed with knee osteoarthritis. Methods: A prospective clinical trial was conducted in the Department of Orthopedics and Traumatology II from the Clinical County Hospital, Tîrgu Mureș, Romania. Thirty-five patients diagnosed with idiopathic knee osteoarthritis received two intraarticular injections with hyaluronic acid-based hydrogel (24 mg of hyaluronic acid/3 ml) at one-week interval. Anteroposterior radiographs were obtained before the injections, at six and twelve months after. Minimum joint space width was measured by two senior orthopaedics surgeons at each follow up. Each radiograph was measured again by the same evaluators two weeks apart. Results: Thirty-one patients were present at the final follow-up. A minor reduction in mean weight was noticed (from 82.2 kg ± 16.2 kg to 80.9 kg ± 16.0, p > 0.398) without any correlation with joint space width narrowing. There were no major changes at the first follow up (6 months) regarding joint space narrowing. A reduction in joint space width was observed however at 12 months varying from 4.4 mm (SD ± 1.64, range 1.8-7.1) at the first assessment to 4.3 mm (SD ± 1.26, range 0.0-6.8) at the final follow-up but with no statistical difference (p=0.237). Conclusion: No significant modification in joint space width at the final follow-up secondarily proved that two injections of Hymovis® may slow down narrowing in the knee joint space over a one-year period.

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Anterolateral Portal Is Less Painful than Superolateral Portal in Knee Intra-Articular Injection

Cited by 11 publications

References 15 publications

Difference in pain and accuracy of two hyaluronic acid injection techniques for symptomatic knee osteoarthritis in overweight patients

Difference in pain and accuracy of two hyaluronic acid injection techniques for symptomatic knee osteoarthritis in overweight patients

Enhanced arthrocentesis of the effusive knee with pneumatic compression

Changes in Knee Joint Space Width in Treatment with a New Hyaluronic-Based Hydrogel

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