Aspiration and Injection of the Knee Joint: Approach Portal

Douglas, R J W

doi:10.5792/ksrr.2014.26.1.1

Cited by 40 publications

(31 citation statements)

References 27 publications

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“…The task force agreed that lateral mid and superolateral patellar approaches must be preferred to the anterior routes, as advised in many publications. [35][36][37][38] The experts underlined that providers practicing viscosupplementation have to be familiar with the different approaches to adapt to any situation that may present. Imaging guidance, using either ultrasound or fluoroscopy, was unanimously recommended by the task force for hip and ankle, and strongly recommended for trapeziometacarpal, temporomandibular joint, and for shoulder.…”

Section: /Strongmentioning

confidence: 99%

EUROVISCO Recommendations for Optimizing the Clinical Results of Viscosupplementation in Osteoarthritis

et al. 2018

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Objectives The 3 aims of the work were to identify population subgroups that can benefit the most from viscosupplementation (VS), to provide recommendations on injection techniques, and to discuss VS appropriateness in clinical situations that are commonplace in daily practice. Methods The task force members voted on their degree of agreement on 27 statements, 36 recommendations, and 22 clinical scenarios using a 9-point scale. The strength of agreement/appropriateness/recommendation (SOA/SOR) was classified as strong if the median agreement score was ≥8. The level of consensus (LOC) was also obtained. Results Among the assumed predictors for VS failure, obesity, radiographic severity, large synovial fluid effusion, severe patellofemoral involvement, major malalignment, and gross joint instability received a large majority of agreements. The lateral mid-patellar approach was recommended for knee injection. Imaging guidance was unanimously recommended for hip and ankle. Agreement was achieved to strictly respect the dosing regimen proven by controlled trials. There was agreement for treating with VS patients with mild to moderate knee and hip OA, with normal weight or moderate overweight, insufficiently improved by first-line therapies, or who do not wish get oral treatment or who have contraindications to pain killers. The group considered the patient's wishes as a key element in therapeutic decision making. Conclusion Based on literature data and clinical experience, the EUROVISCO group proposed a set of recommendations for optimizing the results of VS, aimed to help practitioners, especially in some cases in which the patients' specificities make the therapeutic decision difficult.

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Section: /Strongmentioning

confidence: 99%

EUROVISCO Recommendations for Optimizing the Clinical Results of Viscosupplementation in Osteoarthritis

et al. 2018

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“…The arthrocenteses were performed on fresh specimens, within 30 min of the limb amputation. The knee joint arthrocentesis was performed via either the superolateral or the superomedial approach [ 10 ]. The arthrocentesis site was aseptically prepared using the same technique as for a joint aspiration or injection of the knee [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

Inadvertent Introduction of Tissue Coring Into Joints During Arthrocentesis: An Experimental Study

Xu¹,

Peng²,

Chai³

et al. 2017

Med Sci Monit

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BackgroundThe aim of this study was to investigate whether needles introduce skin plugs into joints during arthrocentesis.Material/MethodsIn the first part of this study, the arthrocentesis site was scrubbed with a fluorescein sodium swab, and 90 needles were inserted through the joint tissue and collected for examination under a fluorescence microscope. In the second part of this study, the joints were injected using 720 needles of different gauges. Two different randomly assigned needle insertion techniques were used: needle insertion straight through the joint capsule (subgroup 1) or insertion of the needle into the subcutaneous tissue followed by flushing of the needle with 0.5 mL of 0.9% normal saline prior to advancing the needle through the joint capsule (subgroup 2).ResultsOf the 90 needle tips examined in the first part of this study, 21 had high-grade fluorescein contamination. In the second part of this study, the incidence of tissue, epidermis, and dermis contamination in subgroup 1 was 57.2%, 43.1%, and 25.0%, respectively. There was no significant difference in the incidence among different gauge needles, except for a difference in epidermis contamination between the 21-gauge and 23-gauge needles. Compared to subgroup 1, subgroup 2 had a significantly lower OR for tissue contamination.ConclusionsIt is common to introduce tissue coring with epidermis and dermis into the joint during arthrocentesis, which poses a potential risk for septic arthritis. However, tissue contamination of the joint may be reduced by flushing saline through the needle into the subcutaneous tissues prior to entering the joint capsule.

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“…Each patient was placed in a supine position with the knee exed at 10 ~ 15 degrees. Under ultrasound guidance, a sample of about 1 mL of synovial uid was aspirated from the suprapatella bursa via the superomedial or superolateral approach before the rst injection and 2 weeks after the last injection [19]. The synovial uid samples were stored at -30℃ for further analysis.…”

Section: Sample Correction and Preparationmentioning

confidence: 99%

Identification of early response to hypertonic dextrose prolotherapy markers in knee osteoarthritis patients by an inflammation-related cytokine array

Kuo¹,

Pan²,

Wang³

et al. 2020

Preprint

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BACKGROUND/AIMOsteoarthritis (OA) is one of the most common forms of arthritis, and hypertonic dextrose prolotherapy has long been used clinically to treat knee OA. The aim of this study was to investigate the inflammation-related protein-expression profile characterizing the efficacy of the hypertonic dextrose prolotherapy in knee OA as prognostic markers.METHODSOA patients over the age of 65 were recruited for Western Ontario McMaster University Osteoarthritis (WOMAC) index, knee X ray evaluation and knee joint synovial fluid analysis before and after hypertonic dextrose prolotherapy. The expressions of inflammation-related factors were measured using a novel cytokine antibody array methodology. The cytokine levels were quantified by quantitative protein expression and analyzed by ELISA using the patients’ knee-joint synovial fluid. The WOMAC Index and minimum joint space width prior to receiving the intra-articular injection and at 2-week intervals were compared.RESULTS12 patients who received OA intervention were enrolled and finally a clinical evaluation of 12 knee joints and knee synovial fluid samples were analyzed. In this study, after receiving hypertonic dextrose prolotherapy, the OA patients clearly demonstrated a significant improvement in WOMAC index and increasing tendency in the medial minimum joint space width after intervention. Meanwhile, we observed a significantly associated tendency between the high-glucose treatment of knee OA and the upregulation of MMP2, TIMP-1, EGF, CXCL9 and IL-22. These findings provide knee OA patients receiving hypertonic dextrose prolotherapy, which accompanying with the improvement of knee pain, stiffness, and function and increasing tendency in the medial minimum joint space width.

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Aspiration and Injection of the Knee Joint: Approach Portal

Cited by 40 publications

References 27 publications

EUROVISCO Recommendations for Optimizing the Clinical Results of Viscosupplementation in Osteoarthritis

EUROVISCO Recommendations for Optimizing the Clinical Results of Viscosupplementation in Osteoarthritis

Inadvertent Introduction of Tissue Coring Into Joints During Arthrocentesis: An Experimental Study

Identification of early response to hypertonic dextrose prolotherapy markers in knee osteoarthritis patients by an inflammation-related cytokine array

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