Evaluation of the Effectiveness of the Medial Parapatellar Knee Injection Technique
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 45
- 试验地点
- 1
- 主要终点
- The percentage of successfull intra-articular deposits of radiocontrast dye into the knee joint using our medial parapatellar joint line approach and comparison of this value to previously reported values in the literature
研究概览
简要总结
The goal of our study is to present important anatomic considerations which should be considered before knee injection is performed. Additionally, we have developed important procedural augments to the traditional para-patellar injection techniques in order to exceed the accuracy and safety previously reported for the infra-patellar approaches We have developed an injection technique which mechanically is similar to current techniques practiced and poses no additional risks or discomfort to the patient. The basis of our technique and its success is through recognition of anatomic factors and avoidance of possible iatrogenic injuries which exist when using other knee injection technique. The focus of our study is to validate the clinical accuracy we have been obtaining using our technique through fluoroscopically confirmed visualized confirmation of repeated intra-articular deposit. Additionally we want to document the range of needle length we require to properly access the knee joint in our population to substantiate the importance of needle length. Needle length is a critical factor in obese patients whom have larger infra-patellar fat pads.
Our hypothesis is that when using a 6 inch 22 gage needle for intra-articular knee injections through the medial joint line approach, while utilizing the medial wall of the lateral femoral condyle as an intra-articular stop point for needle insertion, the accuracy of intra-articular deposit will exceed the values currently reported in the literature which is approximately 75% success rate.
To prove this point we will be injecting 2 cc of radiocontrast dye into the joint space and than immediatly view the joint flouroscopicly after the knee has been brought through 10 cycles of flexion and extension.
详细描述
Injection into the knee joint, although considered a remedial procedure by much of the medical community, is not as easy a procedure to reproducibly and accurately perform as one would believe. Numerous authors have estimated that between 20 to over 30 percent of knee injection procedures fail to deposit the injectate into the joint space (6),(7),(9) (11). In response to the reportedly high complication rates associated with intra-articular deposit of injectate, numerous authors have published different techniques, injection sites, and tricks to help the clinician. Techniques such as air arthrography (12)(13), the backflow technique (7), the triangle technique (11), and others have added complexity and time to a seemingly easy procedure.
Specific anatomic relationships within the knee joint provide larger access windows and relatively easier entry for some techniques than for others. Additionally, the presence of hyaline articular cartilage, the smooth, nonreplicable joint surface integral to the efficient and pain free articulation of joints adds another complexity and concern in access to the knee joint. Iatrogenic damage to this cartilage is probable with some commonly employed injection techniques. Damage to the articular surface is the anatomic equivalent of arthritic pathologic change within the knee joint.
Much of the confusion surrounding accurate intra-articular injection stems from the anatomic relationships we are taught during our training. Anatomical atlases depict the layers of the knee joint in such a fashion as there being a tangible and recognizable joint space to easily insert a needle. This is not the case in the normal knee which does not have a knee effusion. The reality is that the normal adult knee has 2 cc of synovial fluid dispersed as an extremely thin film over the top of the articular cartilage. The synovial membrane in effect rests directly on top of the articular cartilage and hence the joint space is actually a potential space. Even though this is the case, there are three predominate areas of recess within the knee joint where if the needle is accurately placed, this potential space can be developed. These three regions are the inter-trochlear groove, inter-condylar notch, and the suprapatellar pouch.
The inter-trochlear groove is the region on the anterior surface of the femur which lies directly below the patella when the knee is in its extended position. The inter-trochlear groove is covered with articular cartilage which is integral in maintaining normal pain free patellofemoral articulation.
The inter-condylar notch is a region of the femur on its most distal aspect which houses the ACL and PCL tendons. The inter-condylar notch is not an articular region of the knee joint and is not covered with articular cartilage. The fact that there is no articular cartilage in the inter-condylar notch significantly reduces chances of iatrogenic cartilage damage. Placement of the needle precisely into one of these spaces is crucial for a successful injection.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 5 Years 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Patients enrolled in this study are those whom present to our institution for elective knee arthroscopy. All patients scheduled to receive a knee arthroscopy scheduled through the office of Dr. Harold Battenfield will be asked to participate in the study on the day of their procedure as long as they do not fall into one of the exclusion criteria categories
排除标准
- •Patients will not be allowed to participate in this study if they have an allergy to iodine or shell fish, if they have a knee effusion diagnosed clinically on the day of surgery, if the knee or surrounding tissues display cellulitis or other signs of infection, or if the patient has had a traumatic accident to their knee which significantly changes its anatomical relationships
结局指标
主要结局
The percentage of successfull intra-articular deposits of radiocontrast dye into the knee joint using our medial parapatellar joint line approach and comparison of this value to previously reported values in the literature
时间窗: one year
次要结局
- The length of the needle which is required to successfully transverse the infrapatellar fat pad in order to deposit injectate into the knee joint(one year)