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Knee Injection Technique - Easy Tutorial | OrthoFixar 2024

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Procedure

Knee Injection Technique

Content List

Knee Injection Technique is frequently used as a treatment option for various conditions, such as osteoarthritis, rheumatoid arthritis, and knee injuries. Knee injections can help alleviate pain and inflammation, and can even help delay the need for surgery in some cases.

Related Anatomy

The knee joint has a potential capacity of approximately 120 ml or more in the average-sized adult. The capsule is lined with synovium, which is convoluted and thus has a large surface area; in the larger knee, therefore, more volume will be required to bathe all the target area. Plicae, which are bands of synovium, might exist within the joint and can also become inflammed. The suprapatellar pouch is a continuum of the synovial capsule. and there are many bursae around the joint.

Equipment Needed

SyringeNeedleAdcortylLidocaineTotal volume
10 mlGreen, 21 gauge
1.5 inches (40 mm)
40 mg Adcortyl5 ml, 1%9 ml

Knee Injection Techniques

A variety of approaches have been described for access to the intra-articular space for knee injection (superolateral, superomedial, inferolateral and inferomedial). The superolateral knee injection has been shown to be the most accurate and reproducible (93% accuracy as compared to 71–75% for the inferomedial and inferolateral approaches).

See Also: Hyaluronic Acid Injection

Superolateral Approach

Knee Injection Technique using superolateral approach can be described as following step by step:

  • Patient in the supine position with the knee fully extended.
  • Examine the knee to determine the approximate amount of joint fluid present (will dictate the size of syringe utilized for aspiration) and look for evidence of overlying cellulitis (avoid placing the needle through any area of potential infection).
  • Palpate the superolateral aspect of the patella and mark the skin one fingerbreadth superior and one fingerbreadth lateral to this location as the starting point .
  • Prep the skin in this region using alcohol and povidone-iodine.
  • Put on sterile gloves.
  • The non-dominant hand can be used to evert the patella slightly, increasing the available space and ease of needle insertion into the intra-articular space.
  • The needle should be directed 45° distally and 45° posteriorly into the intra-articular space with care taken to avoid hitting the articular surfaces of the patella or corresponding trochlea.
  • Once in the intra-articular space, begin injection of the prepared medication.
  • Following the injection, the needle is removed from the knee. The prepped skin is cleaned with an alcohol swab, dried with a gauze pad and a band-aid is applied.
See Also: Prolotherapy Injection
Knee Injection Technique Superolateral Approach
Knee Injection Technique Superolateral Approach

Inferolateral Approach

Knee injection technique using inferolateral approach can be described as following step by step:

  • Place the patient in the seated position with the knee flexed over the end of the examination table to 90°.
  • Palpate the inferior pole of the patella. The lateral aspect of the patellar tendon and the proximal aspect of the lateral tibial plateau. A palpable “soft spot” should be present one fingerbreadth proximal to the lateral tibial plateau just lateral to the lateral aspect of the patellar tendon. Mark this location as the starting point for the aspiration/injection
  • Prep the skin in this region using alcohol and povidone-iodine.
  • Put on sterile gloves.
  • The needle should be directed from the soft spot starting point approximately 30° medially toward the intercondylar notch taking care to avoid contacting the articular surface of the femoral condyle
  • Once in the intra-articular space start injecting the prepared medication once the needle is within the intra-articular space.
  • Following the injection, the needle is removed from the knee. The prepped skin is cleaned with an alcohol swab, dried with a gauze pad and a band-aid is applied.
Knee Injection Technique Inferolateral Approach
Knee Injection Technique Inferolateral Approach

After knee injection, avoid undue weight-bearing activity until symptoms abate, and then start strengthening and mobilizing exercises. One study found that total bed rest for 24 hours after injection in rheumatoid knees shows better results; however, the bed rest involved hospital stay, which is not cost-effective.

Notes

In obese patients using a longer needle and a larger volume of 40 mg of Adcortyl, enables more of the joint surface to be bathed. Hyaluronans may be injected but are more expensive than corticosteroids injections and do not appear to have longer lasting benefits.

The knee injection provides a variable length of pain relief, but if the knee is not overused this may be prolonged. Repeat injections can be given at intervals of not less than 3 months, with an annual x-ray to monitor joint degeneration. If the patient is awaiting surgery, discuss with the surgeon before proceeding.

References & More

  1. Injection Techniques in Musculoskeletal Medicine. A Practical Manual for Clinicians In Primary And Secondary Care. Fifth Edition
  2. Emergency Room Orthopaedic Procedures: An Illustrative Guide for the House Officer Book by Eric J. Strauss and Kenneth A. Egol.
  3. Chernchujit B, Tharakulphan S, Apivatgaroon A, Prasetia R. Accuracy comparisons of intra-articular knee injection between the new modified anterolateral Approach and superolateral approach in patients with symptomatic knee osteoarthritis without effusion. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2019 Mar 26;17:1-4. doi: 10.1016/j.asmart.2019.02.001. PMID: 30976521; PMCID: PMC6438910.
  4. Fusco G, Gambaro FM, Di Matteo B, Kon E. Injections in the osteoarthritic knee: a review of current treatment options. EFORT Open Rev. 2021 Jun 28;6(6):501-509. doi: 10.1302/2058-5241.6.210026. PMID: 34267940; PMCID: PMC8246115.
  5. Testa G, Giardina SMC, Culmone A, Vescio A, Turchetta M, Cannavò S, Pavone V. Intra-Articular Injections in Knee Osteoarthritis: A Review of Literature. J Funct Morphol Kinesiol. 2021 Feb 3;6(1):15. doi: 10.3390/jfmk6010015. PMID: 33546408; PMCID: PMC7931012.
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