Comparison of radiological and clinical results of knee intra-articular injections with two ultrasonography-guided approach techniques: A randomized controlled study

Esra Ertilav1, Sinem Sarı2, Devran Ertilav3, Osman Nuri Aydın4

1Department of Algology, Mehmet Akif Ersoy State Hospital, Çanakkale, Türkiye
2Department of Anesthesiology and Reanimation, Adnan Menderes University Medical Faculty, Aydın, Türkiye
3Department of Orthopedics and Traumatology, Biga State Hospital, Çanakkale, Türkiye
4Department of Algology, Adnan Menderes University Medical Faculty, Aydın, Türkiye

Keywords: Chronic pain, infrapatellar approach, intra-articular injection, knee injection, knee osteoarthritis, suprapatellar approach, suprapatellar bursa, ultrasound-guided injection.

Abstract

Objectives: The objective of this study was to evaluate the clinical and radiological results of intra-articular injections performed with two different ultrasound-guided approaches in knee osteoarthritis.

Patients and methods: The randomized controlled study was conducted on 80 knees of 40 patients (9 males, 31 females; mean age: 63.6±8.2 years; range, 46 to 78 years) with Grade 2-3 gonarthrosis that underwent ultrasound-guided intra-articular injections with suprapatellar (SP) or infrapatellar (IP) approaches between March 2020 and January 2021. After the injection, opaque material spread was fluoroscopically observed. Before the procedure and at the one and three months after the procedure, patients' Visual Analog Scale (VAS) scores for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for functional recovery were recorded.

Results: In both techniques, one- and three-month VAS and WOMAC scores were found to be significantly lower (p<0.001 and p<0.001, respectively). Of the patients with positive opaque spread, 63.3% were in the IP technique group, and 36.7% were in the SP technique group (p=0.003). In 69.2% of those with radiologically positive opaque spread, the VAS score was significantly higher with >50% regression (p=0.04). In the IP technique, >50% regression rate of the VAS was 86.7% in patients with positive opaque spread, while VAS regression was significantly higher than those without opaque spread (p=0.02).

Conclusion: Although the IP approach shows an early-positive opaque transition due to its proximity to the joint, both approach techniques are clinically effective under ultrasound guidance.

Citation: Ertilav E, Sarı S, Ertilav D, Aydın ON. Comparison of radiological and clinical results of knee intra-articular injections with two ultrasonography-guided approach techniques: A randomized controlled study. Arch Rheumatol 2023;38(2):230-237. doi: 10.46497/ArchRheumatol.2023.9382.

Ethics Committee Approval

Approval was obtained from the Interventional Clinical Research Ethics Committee (2020/03). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Idea/concept, design: E.E., S.S.; Control/supervision, critical review: E.E., S.S., O.N.A.; Data collection and/or processing, writing the article: E.E., D.E.; Analysis and/or interpretation: E.E., D.E., S.S.; Literature review: E.E., D.E., S.S., O.N.A.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.