Korean J Pain.  2018 Oct;31(4):289-295. 10.3344/kjp.2018.31.4.289.

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

• Choi JW
• Lee JH
• Ki M
• Kim MJ
• Kang S
• Lee J
• Lee JR
• Han YJ
• Son JS

• KMID: 2421520
• DOI: http://doi.org/10.3344/kjp.2018.31.4.289

Abstract

BACKGROUND
The 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.
METHODS
A 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.
RESULTS
There 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).
CONCLUSIONS
The anterolateral approach to the lateral femoral condyle, using ultrasound, is an alternative method to the approach targeting the medial femoral condyle, using shorter needle.

Keyword

Epiphyses; Femoral condyle; Intraarticular injections; Knee joint; Needle; Osteoarthritis; Synovial membrane; Ultrasound

MeSH Terms

Epiphyses
Humans
Injections, Intra-Articular*
Knee Joint
Knee*
Methods
Needles
Osteoarthritis
Synovial Membrane
Ultrasonography*

Figure

• 

  Fig. 1 Anatomical representation using a plastic model. This is a reproduced knee with 90-degree flexion in the supine position. Anatomic landmarks are marked on the photograph. Anterolateral portal (ALP) is presented in a small circle. LC: lateral femoral condyle, MC: medial femoral condyle, IPT: infrapatellar tendon, LTP: lateral tibial plateau.

• 

  Fig. 2 Photographs and ultrasound image for procedure. The knee was in 90 degrees flexed position. The entry point of the needle is about 1.5 cm far from the lateral margin of the infrapatellar tendon. The direction of the needle and the target point are shown. (A) Group I: anterolateral approach to the medial condyle. The ultrasound probe was placed over the anteromedial portal so that the ultrasound beam was approximately at the right angles to the needle shaft optimizing visualization of the location of the needle engaged to the medial femoral condyle. (B) Group II: anterolateral approach to the lateral condyle. The ultrasound probe was placed over the central portion of the tibial plateau, and then caudally tilting until a clear lateral condyle image was seen. If the needle was not able be seen, the needle was advanced depending on the movement of tissue planes around the needle. LC: lateral femoral condyle, MC: medial femoral condyle, IPT: infrapatellar tendon, LTP: lateral tibial plateau, C: cartilage.

• 

  Fig. 3 Flow chart showing the distribution of study patients from initial contact to completion of the study. One case received the injection by group I method due to an error in group II.

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