Comparison of four different intra-articular injection sites in the knee: a cadaver study

Abstract

Although intra-articular knee injection is not a complicated procedure, it could be difficult to assess whether the tip of the needle lies free in the joint or is embedded in synovium or other intra-articular soft tissues. The purpose of this study was to evaluate the accuracy rate of intra-articular injection using anteromedial (AM), anterolateral (AL), lateral midpatellar (LMP), and medial midpatellar (MMP) portals in cadavers. In this study 156 knees of 78 fresh cadavers were included. Anterolateral and AM injection to both knees of 39 cadavers (78 knees) were performed. MMP and LMP injection to both knees of other 39 cadavers were also performed. Accuracy rate was the highest (85%) in the AL injection portal and lowest in the MMP portal (56%). In conclusion, the accuracy obtained with use of the MMP portal was significantly lower than that obtained with the use of either the AM (P < 0.05), AL (P < 0.0001), or LMP (P < 0.05) portal. Although AL injection site resulted in good intra-articular delivery with 85% accuracy rate and with a lower incidence of soft tissue infiltration, the results were not statistically significant when compared to AM and LMP portals. Therefore, any of these three portals might be preferred depending on the experience of the physician. On the other hand, 100% accuracy could not be obtained through any portals in the study, which should be kept in mind when treating knee problems with intra-articular medications.

The outcomes and cost-effectiveness of intraarticular injection of the rheumatoid knee

“…Selection of an optimal anatomic portal is critical for accuracy, adds no additional cost to an intraarticular procedure, and is certainly to be recommended [4][5][6][7][8][9][10][11][12]. There is also compelling evidence that formal arthrocentesis should be performed prior to injection [2,6].…”

“…There is growing evidence that use of image guidance improves injection accuracy; however, there are concerns that image guidance is expensive (150-200% increase in costs) and thus not cost-eVective [5,[11][12][13][14]. Therefore, the role of safe low-cost methods to improve intraarticular injection outcomes is assuming greater importance [2,[4][5][6][7][8][9][10][11][14][15][16].…”

“…Intraarticular corticosteroid injection is eVective for the symptomatic knee in rheumatoid arthritis; however, therapeutic response can be highly variable [1][2][3][4][5][6][7][8][9][10][11]. There is growing evidence that use of image guidance improves injection accuracy; however, there are concerns that image guidance is expensive (150-200% increase in costs) and thus not cost-eVective [5,[11][12][13][14].…”

A physiotherapy perspective of musculoskeletal imaging in sport

“…This is now a relevant issue for physiotherapists as many working in an extended scope role in the NHS are now performing injections. It has been documented that 14-71% of injections carried out ''blind''-without image guidance-miss their target [23][24][25][26][27]. What we do not know is whether this makes a difference in clinical efficacy.…”

Efeito da associação da triancinolona à viscossuplementação do joelho

“…Estudos com fluoroscopia apontam para um erro de posicionamento em até 29% das injeções 135 . A via de acesso escolhida no presente estudo foi a anterolateral, via de escolha utilizada em nosso grupo, e que apresenta maior índice de acurácia segundo alguns autores 134 .…”