The comparison of two different intraarticular injections using a sonographic anterolateral approach in patients with osteoarthritic knee

Abstract

BackgroundThe intraarticular (IA) injection has become popular for the management of the osteoarthritic knee without an effusion. The success rate of IA injection would be better if it was able to be visually confirmed. We hypothesized that an anterolateral approach, which targets the synovial membrane of the lateral condyle using ultrasound, would provide an equivalent alternative to the anterolateral approach, targeting the synovial membrane of the medial condyle for IA injection of the knee.MethodsA total of 96 knees with osteoarthritis were randomized placed into the two groups, which were group I (anterolateral approach to the medial condyle) and group II (anterolateral approach to the lateral condyle). The primary outcome was to compare the success rate of the two methods of IA injection. The required length of the needle for injection was also measured and compared. Pain intensity was assessed using the Numeric Rating Scale in order to evaluate the success of injection.ResultsThere were no significant differences in the success rate between both groups. The success rate of group I and group II were 87.8% (95%, CI 78.7–97.0) and 91.5% (95%, CI 83.6–99.5), respectively (P = 0.549). The needle depth was 5.0 ± 0.8 (3.0 to 6.1 cm) in group I, and 3.0 ± 0.8 (1.5 to 5 cm) in group II (P < 0.001).ConclusionsThe anterolateral approach to the lateral femoral condyle, using ultrasound, is an alternative method to the approach targeting the medial femoral condyle, using shorter needle.

Enhanced arthrocentesis of the effusive knee with pneumatic compression

“…[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.…”

“…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. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] The anterolateral portal is defined by the adjoining structures of lateral border of the patella, the lateral border of the patellar tendon, and the lateral tibial plateau with the entry point adjacent to the lateral patellar tendon, and thus avoids the lateral geniculate artery. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] The anterolateral approach uses the cartilage surface of the medial femoral condyle to determine the joint surface-synovial membrane interface and this is defined by a palpable "hard-stop" where the needle cannot go further.…”

“…13 Similarly, Chavez-Chiang et al and Choi et al demonstrated similar accuracy at 93% and 87.8% respectively even without synovial fluid return. 12,17 Further, Lee et al found the anterolateral portal was less painful than the superolateral approach yet had identical clinical results. 15 Chernchujit et al found that a modified anterolateral approach was more accurate that the standard superolateral approach.…”

“…An important aspect of the compression-assisted flexed knee technique is that a 5.1 cm (2-inch) needle is usually necessary so that the needle tip can predictably and effectively access the synovial space overlying the femoral condyle when utilizing the anterolateral portal. [12][13][14][15][16][17] Further, even though pneumatic compression forced fluid from the superior knee to the inferior knee where it could be accessed, the layering of the fluid over the femoral condyles was quite shallow dimensionally due to the presence of the overlying fat pad (Figures 2 and 3); thus positioning of the needle tip and bevel depth-wise was important for continued synovial fluid return. After the pneumatic thigh cuff inflated to 100 mm Hg, additional fluid return was not always immediate, but often required 1 to 3 minutes to permit synovial fluid to move from the superior knee to the inferior knee where it would accumulate.…”

<p>Usefulness of patellar cartilage cross-sectional area for knee tibiofemoral osteoarthritis in elderly</p>

“…The pathophysiology of KOA is complex. Although the loss of the patellar cartilage is a major factor, inflammatory effects and some other causes such as depression and subjective quality of feeling may also affect pain intensity and unpleasantness 30–36. Second, there might be measurement errors associated with analyzing the PCA on knee MRI.…”