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Ultrasound-Guided Knee Injections Are More Accurate Than Blind Injections: A Systematic Review of Randomized Controlled Trials. Arthrosc Sports Med Rehabil 2021; 3:e1177-e1187. [PMID: 34430899 PMCID: PMC8365196 DOI: 10.1016/j.asmr.2021.01.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/30/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose To review the current literature to determine which injection technique and needle portal placement provide the greatest accuracy for intra-articular access to the knee. Methods This study followed Preferred Reporting Items and Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted in March 2020 and repeated in May 2020 using electronic databases PubMed, MEDLINE, and the Cochrane Library. Data on the accuracy of intra-articular knee injection (successful injections/total number of injections) were collected. Only Level I studies were included. Study design, demographic variables, needle sizes, and method of validating accuracy were recorded. The Jadad score was used to assess methodologic quality, and a risk-of-bias assessment was performed. Results A total of 12 Level I human studies (1431 patients, 1315 knees) were included in this review. Seven of the studies did a direct comparison between ultrasound-guided and blind knee injections. Ultrasound-guided injections were more accurate compared with blinded knee injections in every study. The most accurate anatomical approach was an isometric quadricep contraction method with the superolateral approach. Conclusions This study showed that ultrasound-guided knee injections were more accurate across every anatomical needle injection site compared with blind injections. Injections made by a blind/anatomically guided method had inconsistent accuracy rates that seemed highly dependent on the portal of entry. Level of Evidence Level I, systematic review of Level I studies.
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Dulic O, Lalic I, Kecojevic V, Gavrilovic G, Abazovic D, Miskulin M, Maric D, Bumbasirevic M. Do knee injection portals affect clinical results of bone marrow aspirate concentrate injection in the treatment of osteoarthritis? A prospective randomized controlled study. Regen Med 2020; 15:1987-2000. [PMID: 33151802 DOI: 10.2217/rme-2020-0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: To explore the effect that the location of needle placement has on efficacy and tolerability of bone marrow aspirate concentrate injections during treatment of knee osteoarthritis. Methods: Bone marrow aspirate concentrate injections were administered to 111 patients via superolateral, anteromedial or anterolateral portals. Pain was assessed by visual analog scale before and 3, 7, 14 and 21 days after intervention. Knee function was assessed by Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score and International Knee Documentation Committee scores before and 1, 3, 6, 9 and 12 months after intervention. Results: Significant differences in Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score and International Knee Documentation Committee scores were observed 12 months post intervention compared with baseline (p < 0.001 for all comparisons). No significant differences in outcome or pain scores were observed among groups. Conclusion: All portals demonstrated similar clinical benefits up to 12 months after intervention. Trial registration number: ClinicalTrials.gov (NCT03825133).
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Affiliation(s)
- Oliver Dulic
- University of Novi Sad, Medical Faculty, Clinical Center of Vojvodina, Department for Orthopedic Surgery & Traumatology, Hajduk Veljkova 1-9, Novi Sad, Serbia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Ivica Lalic
- University of Novi Sad, Medical Faculty, Clinical Center of Vojvodina, Department for Orthopedic Surgery & Traumatology, Hajduk Veljkova 1-9, Novi Sad, Serbia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Vaso Kecojevic
- University of Novi Sad, Medical Faculty, Clinical Center of Vojvodina, Department for Orthopedic Surgery & Traumatology, Hajduk Veljkova 1-9, Novi Sad, Serbia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Gordan Gavrilovic
- Atlas Hospital, Osmana Djikica 5, Belgrade, Serbia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Dzihan Abazovic
- Renova Hospital, Osmana Djikica 5, Belgrade, Serbia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Mladen Miskulin
- Specijalna bolnica za Neurokirurgiju i ortopediju Aksis, Zagreb, Petrovaradinska 1, 10000 ZAGREB, Croatia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Dusan Maric
- MD Orto Hospital, Futoski put 115, Novi Sad, Serbia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Marko Bumbasirevic
- University of Belgrade, Medical Faculty, Clinical Center of Serbia, Clinic for Orthopedic Surgery & Traumatology, Dr. Subotica 20, Belgrade, Serbia.,Department for Orthopedic Surgery & Traumatology Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
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Wada M, Fujii T, Inagaki Y, Nagano T, Tanaka Y. The Isometric Quadriceps Contraction Method for Intra-Articular Knee Injection. JBJS Essent Surg Tech 2019; 9:e16. [PMID: 31579534 DOI: 10.2106/jbjs.st.18.00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The intra-articular injection is the most important technique for treating not only rheumatoid arthritis but also osteoarthritis of the knee. However, 1 problem is that the drug is often inaccurately injected outside of the joint, especially when no effusion is present. According to a previous systematic review by Maricar et al., the use of a superolateral patellar approach without ultrasonography had a higher success rate (87%) than both a medial midpatellar approach (64%) and an anterolateral joint-line approach (70%). For knees with little effusion, we devised a method of intra-articular injection in which the needle is inserted into the suprapatellar pouch while the patient maintains isometric contraction of the quadriceps. This method, which we call the isometric quadriceps contraction (IQC) method, is based on the concept that isometric contraction of the quadriceps induces contraction of the articularis genus muscle complex, thus expanding the volume of the suprapatellar pouch. The major steps of the procedure are (1) patient positioning and knee placement, (2) finding the puncture point, (3) isometric quadriceps contraction, and (4) needle approach to the suprapatellar pouch and injection. We also show the ultrasound evaluation of the suprapatellar pouch expansion under IQC and the accuracy of the IQC method compared with that of the non-activated quadriceps method. The results of this injection method indicate that the suprapatellar pouch is likely to expand during IQC, improving the probability of successful intra-articular injections. We believe that the IQC method is therapeutically effective and achieved a success rate of 93.3% despite the presence of little effusion and no use of ultrasonography.
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Affiliation(s)
- Makoto Wada
- Department of Orthopaedic Surgery, Wada Orthopaedic Clinic, Osaka, Japan
| | - Tadashi Fujii
- Department of Orthopaedic Surgery, Kashiba Asahigaoka Hospital, Nara, Japan
| | - Yusuke Inagaki
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Tatsuo Nagano
- Department of Orthopaedic Surgery, Nagano Orthopaedic Clinic, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
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