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First published on April 16, 2004, doi:10.1177/0363546503258703
This version was published on June 1, 2004
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The American Journal of Sports Medicine 32:1029-1031 (2004)
© 2004 American Orthopaedic Society for Sports Medicine

A Simple, Accurate Method to Confirm Placement of Intra-articular Knee Injection

Rudolph C. Glattes, MD*, Kurt P. Spindler, MD{dagger},*, Gordon M. Blanchard, MD*, Michael T. Rohmiller, MD*, Eric C. McCarty, MD* and Jake Block, MD{ddagger}

From the * Department of Orthopaedics and Rehabilitation and the {ddagger} Department of Radiology, Vanderbilt Sports Medicine Center, Nashville, Tennessee

{dagger} Address correspondence to Kurt P. Spindler, MD, Vanderbilt Sports Medicine Center, 2601 Jess Neely Drive, Nashville, TN 37212 (e-mail: kurt.spindler{at}vanderbilt.edu).

Background: Intra-articular knee injections are routinely performed in clinical practice without documenting intra-articular placement.

Hypothesis: A small amount of air to an intra-articular knee injection produces an audible "squishing" sound with range of motion.

Study Design: Prospective nonrandomized clinical trial.

Methods: The study group (20 knees from 20 patients) received an intra-articular injection with a mixture of local anesthetic, corticosteroid, contrast dye, and 1 to 2 cc of air. The control group (10 knees from 5 patients) received extra-articular injections of a mixture of local anesthetic, contrast dye, and 2 cc of air. All knees were examined immediately after injection for a squishing sound with range of motion. Postinjection arthrographic radiographs were taken to verify the actual placement.

Result: All study group knees and no control group knees had intra-articular contrast by radiograph. Clearly audible squishing sounds were heard in 17 of 20 study knees (sensitivity of 85%). Squishing sounds were audible in none of the control knees (specificity of 100%).

Conclusion: Adding 1 to 2 cc of air to knee injections provides a no-cost, reliable, sensitive, and specific method of confirming accurate placement.

Clinical Relevance: This simple method is easily reproduced, can confirm accurate placement, and can eliminate extra-articular injection as the reason for clinical response failure.

Key Words: knee • injection • intra-articular • contrast • extra-articular






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