Journal de traumatisme et de traitement

Optimal Needle Placement for Ultrasound-Guided Knee Joint Injections or Aspirations

Abstract

Boqing Chen1, Lawrence P Lai1*, Nitin Putcha2, Todd P Stitik1, Patrick M Foye and Joel A DeLisa

Although the inferomedial and inferior midline approaches are commonly used for intra-articular injection or aspiration of the knee joint, they may not be ideal for optimal needle placement. With these approaches, the fat pad may be contacted, which may lead to the injection of medication in the incorrect region, cause severe pain during the injection procedure, or present a false sign of low yield of fluid aspiration. Therefore, the objective of this study was to compare various approaches for knee injection and aspiration to identify the optimal one for needle placement. In this retrospective study, the ultrasound images of bilateral knee joints in 33 consecutive patients with knee pain were studied. This patient population was divided into two groups: Group A with knee effusions (n=10) and Group B without knee effusions (n=23). The results showed that among 90% of patients in Group A and 100% of patients in Group B, the superolateral view allowed visualization of the greatest amount of intra-articular knee fluid and the least amount of fat pad. In conclusion, the ultrasound-guided superolateral approach appears to be an optimal approach for knee intra-articular injection or aspiration compared to the conventional inferomedial and inferior midline approaches.