Abstract
The intra-articular injection is the most important technique for treating not only rheumatoid arthritis but also osteoarthritis of the knee. However, 1 problem is that the drug is often inaccurately injected outside of the joint, especially when no effusion is present. According to a previous systematic review by Maricar et al., the use of a superolateral patellar approach without ultrasonography had a higher success rate (87%) than both a medial midpatellar approach (64%) and an anterolateral joint-line approach (70%). For knees with little effusion, we devised a method of intra-articular injection in which the needle is inserted into the suprapatellar pouch while the patient maintains isometric contraction of the quadriceps. This method, which we call the isometric quadriceps contraction (IQC) method, is based on the concept that isometric contraction of the quadriceps induces contraction of the articularis genus muscle complex, thus expanding the volume of the suprapatellar pouch. The major steps of the procedure are (1) patient positioning and knee placement, (2) finding the puncture point, (3) isometric quadriceps contraction, and (4) needle approach to the suprapatellar pouch and injection. We also show the ultrasound evaluation of the suprapatellar pouch expansion under IQC and the accuracy of the IQC method compared with that of the non-activated quadriceps method. The results of this injection method indicate that the suprapatellar pouch is likely to expand during IQC, improving the probability of successful intra-articular injections. We believe that the IQC method is therapeutically effective and achieved a success rate of 93.3% despite the presence of little effusion and no use of ultrasonography.
Published outcomes of this procedure can be found at: JBJS Open Access. 2018 Dec 20;3(4):e0003
Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSEST/A250).
References
- 1.Wada M, Fujii T, Inagaki Y, Nagano T, Tanaka Y. Isometric contraction of the quadriceps improves the accuracy of intra-articular injections into the knee joint via the superolateral approach. JBJS Open Access. 2018. December 20;3(4):e003. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Grob K, Gilbey H, Manestar M, Ackland T, Kuster MS. The anatomy of the articularis genus muscle and its relation to the extensor apparatus of the knee. JBJS Open Access. 2017. November 28;2(4):e0034. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Jackson DW, Evans NA, Thomas BM. Accuracy of needle placement into the intra-articular space of the knee. J Bone Joint Surg Am. 2002. September;84(9):1522-7. [DOI] [PubMed] [Google Scholar]
- 4.Maricar N, Parkes MJ, Callaghan MJ, Felson DT, O’Neill TW. Where and how to inject the knee—a systematic review. Semin Arthritis Rheum. 2013. October;43(2):195-203. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Park Y, Lee SC, Nam HS, Lee J, Nam SH. Comparison of sonographically guided intra-articular injections at 3 different sites of the knee. J Ultrasound Med. 2011. December;30(12):1669-76. [DOI] [PubMed] [Google Scholar]