2005 OITE Question 69

Question

An intra-articular knee injection is most accurately administered in which of the following locations?

1- Medial middle to upper patellar with the knee extended

2- Lateral middle to upper patellar with the knee extended

3- Anterior medial at the joint line with knee flexed 90º

4- Anterior lateral at the joint line with knee flexed 90º

5- Posterior medial at the joint line with knee flexed 90º

Figures

Answer (click for answer)

PREFERRED RESPONSE: 2

Jackson et al did a study where they looked at the accuracy of needle placement into the intra-articular space of the knee. The compared the accuracy of using the superior lateral, anterior medial at the joint line, and anterior lateral at the joint line portals in patients who did not have knee effusions. He used fluoro and radiopaque dye to confirm intra-articular placement of the needle. He found that the anterior lateral at the joint line portal was accurate 71% of the time, anterior medial at the joint line was 75%, and superior lateral portal was 93%.

Reference: RECOMMENDED READINGS: Jackson DW, Evans NA, Thomas BM: Accuracy of needle placement into the intra-articular space of the knee. J Bone Joint Surg Am 2002;84:1522-1527.


Greene WB (ed): Essentials of Musculoskeletal Care, ed 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2001, pp 371-372.