The Accuracy of Intra-Articular Needle Placements in
Osteoarthritic Knee Patients: An Arthroscopic Assessment
Sukrom Cheecharean MD*,
Kantapon Kesorn MD**
Affiliation :
* Department of Orthopedics, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
** Department of Orthopedics, Thonburi-Chumphon Hospital, Chumphon, Thailand
Background : The intra-articular of hyaluronic injection is widely used for osteoarthritic knee (knee OA). However, incorrect
needle placement may cause discomfort and reduce effectiveness of the treatment.
Objective : To assess the accuracy rates of needle placements into the intra-articular space of knee OA.
Material and Method: This was a prospective study. Twenty-two patients with knee OA at Rajavithi Hospital received needle
placement into intra-articular spaces using the three approaches, anteromedial (AM), anterolateral (AL), and lying lateral
mid patella (LMP). The accuracy rates were confirmed by arthroscopy. Before and after injection of intra-articular hyaluronic
acid at week 2, the visual analogue scale (VAS) was used to assess pain and the Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC) score was used in the evaluation of knee OA. The quality of life (QoL) was measured using
the generic instrument Short Form-36 (SF-36).
Results : The majority of the participants were female. Their mean age was 58.41±5.82 years old, and their mean (±SD)
BMI was 25.07±2.47 kg/m2. Their VAS and WOMAC scores improved significantly after injection compared to the baseline
(p<0.001), but no significant differences in their QoL (SF-36) were observed after injection. The accuracy rate of
intra-articular needle placement was highest (77.3%) using the LMP, followed by AL (63.6%) and lowest in the AM portal
(31.8%). No significant difference was found between the accuracy rates of any of the needle placement groups based on
KeL grade II. As for KeL stage III, the only significant difference between the accuracy rates was between those of the AM
and the LMP approaches (23.1 vs. 76.9 accuracy rates, p = 0.006).
Conclusion : The LMP approach had the highest accuracy rate and is recommended for the treatment of patients with mild
to moderate knee OA.
Keywords : Intra-articular, Knee osteoarthritis, Anteromedial, Anterolateral, Lying lateral mid patella
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