Lateral versus medial approach for intra-articular knee injections

Year 2015, Volume: 49 Issue: 1, 37 - 40, 19.03.2015

Panayiotis Koulouvaris Marios Lykissas Stavros Ristanis George Aggelidakis Alexandros Mavrodontidis

Abstract

Objective: The aim of this study was to determine whether the medial or the lateral mid-patellar approach is the most reliable for intra-articular knee injections.

Methods: The study included 76 knees of 76 patients divided into 2 groups. The first group consisted of 38 patients with a knee injury and resultant knee effusion. The second group included 38 patients without any known knee pathology. Patients were matched according to age and gender. The medial joint opening (medial patellofemoral angle) was alculated on a T1-weighted transverse image by measuring the anatomic angle between the femur and the patella. The lateral joint opening (lateral patellofemoral angle) was calculated in a similar way.

Results: The medial patellofemoral angle was significantly higher than the lateral patellofemoral angle in both groups (p<0.001).

Conclusion: The medial patellofemoral angle is significantly higher than the lateral patellofemoral angle in both healthy knees and knees with effusion. Therefore, the medial approach appears to be more accurate for intra-articular knee injection due to the medial joint’s larger opening.

Keywords

Intra-articular injection; knee; lateral patellofemoral angle; medial patellofemoral angle;

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Abstract

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Keywords

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References

• Zuckerman JD, Meislin RJ, Rothberg M. Injections for joint and soft tissue disorders: when and how to use them. Geriatrics 1990;45:45-55.
• Wittich CM, Ficalora RD, Mason TG, Beckman TJ. Mus- culoskeletal injection. Mayo Clin Proc 2009;84:831-7.
• Schumacher HR Jr. Aspiration and injection therapies for joints. Arthritis Rheum 2003;49:413-20. CrossRef
• Jackson DW, Evans NA, Thomas BM. Accuracy of needle placement into the intra-articular space of the knee. J Bone Joint Surg Am 2002;84:1522-7.
• Jones A, Regan M, Ledingham J, Pattrick M, Manhire A, Doherty M. Importance of placement of intra-articular steroid injections. BMJ 1993;307:1329-30. CrossRef
• Thomsen TW, Shen S, Shaffer RW, Setnik GS. Videos in clinical medicine. Arthrocentesis of the knee. N Engl J Med 2006;354:19. CrossRef
• Toda Y, Tsukimura N. A comparison of intra-articular hy- aluronan injection accuracy rates between three approach- es based on radiographic severity of knee osteoarthritis. Osteoarthritis Cartilage 2008;16:980-5. CrossRef
• Roberts WN, Hayes CW, Breitbach SA, Owen DS Jr. Dry taps and what to do about them: a pictorial essay on failed arthrocentesis of the knee. Am J Med 1996;100:461-4.
• Esenyel C, Demirhan M, Esenyel M, Sonmez M, Kahra- man S, Senel B, et al. Comparison of four different intra- articular injection sites in the knee: a cadaver study. Knee Surg Sports Traumatol Arthrosc 2007;15:573-7. CrossRef
• Hermans J, Bierma-Zeinstra SM, Bos PK, Verhaar JA, Reijman M. The most accurate approach for intra-articu- lar needle placement in the knee joint: a systematic review. Semin Arthritis Rheum 2011;41:106-15. CrossRef
• Daley EL, Bajaj S, Bisson LJ, Cole BJ. Improving injection accuracy of the elbow, knee, and shoulder: does injection site and imaging make a difference? A systematic review. Am J Sports Med 2011;39:656-62. CrossRef
• Gilliland CA, Salazar LD, Borchers JR. Ultrasound versus anatomic guidance for intra-articular and periar- ticular injection: a systematic review. Phys Sportsmed 2011;39:121-31. CrossRef
• Cunnington J, Marshall N, Hide G, Bracewell C, Isaacs J, Platt P, et al. A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis. Arthritis Rheum 2010;62:1862-9.
• Iizuka M, Yao R, Wainapel S. Saphenous nerve injury following medial knee joint injection: a case report. Arch Phys Med Rehabil 2005;86:2062-5. CrossRef
• Lockman LE. Practice tips. Knee joint injections and aspirations: the triangle technique. Can Fam Physician 2006;52:1403-4.
• Hall S, Buchbinder R. Do imaging methods that guide needle placement improve outcome? Ann Rheum Dis 2004;63:1007-8. CrossRef