Anterolateral Portal Is Less Painful than Superolateral Portal in Knee Intra-Articular Injection
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: Intra-articular knee injections are commonly performed in clinical practice for treating various knee joint disorders such as osteoarthritis and rheumatoid arthritis. When selecting the portal for injection, not only intra-articular needle accuracy but also procedural pain should be taken into consideration. The purpose of this study was to determine whether injection through anterolateral portal provokes less pain and provides better pain relief compared to superolateral portal.Materials and Methods: A total of 60 patients with primary osteoarthritis of the knee receiving intra-articular injections were randomized into 2 groups according to the type of portal approach; anterolateral or superolateral. All patients received hyaluronic acid (20 mg) and triamcinolone (40 mg) as the first injection followed by second and third injections of hyaluronic acid on a weekly basis. Underlying knee pain, procedural pain, and knee pain at 4 weeks were evaluated using visual analogue scale (VAS).Results: Injection through anterolateral portal provoked less pain (VAS, 1.5±1.3) than the superolateral portal (VAS, 1.5 vs. 2.7; p=0.004). No differences were found in the degree of pain relief at weeks between the two groups (p=0.517).Conclusions: We recommend the use of anterolateral portal for intra-articular knee injection as it provokes less pain and comparably short-term pain relief than the superolateral portal.
Abstract
Purpose: Intra-articular knee injections are commonly performed in clinical practice for treating various knee joint disorders such as osteoarthritis and rheumatoid arthritis. When selecting the portal for injection, not only intra-articular needle accuracy but also procedural pain should be taken into consideration. The purpose of this study was to determine whether injection through anterolateral portal provokes less pain and provides better pain relief compared to superolateral portal.Materials and Methods: A total of 60 patients with primary osteoarthritis of the knee receiving intra-articular injections were randomized into 2 groups according to the type of portal approach; anterolateral or superolateral. All patients received hyaluronic acid (20 mg) and triamcinolone (40 mg) as the first injection followed by second and third injections of hyaluronic acid on a weekly basis. Underlying knee pain, procedural pain, and knee pain at 4 weeks were evaluated using visual analogue scale (VAS).Results: Injection through anterolateral portal provoked less pain (VAS, 1.5±1.3) than the superolateral portal (VAS, 1.5 vs. 2.7; p=0.004). No differences were found in the degree of pain relief at weeks between the two groups (p=0.517).Conclusions: We recommend the use of anterolateral portal for intra-articular knee injection as it provokes less pain and comparably short-term pain relief than the superolateral portal.
참고문헌 (17)
- Courtney P, "Joint aspiration and injection and synovial fluid analysis", Best Pract Res Clin Rheumatol, 23, pp.161~192 (2009)
- Lockman LE, "Practice tips. Knee joint injections and aspirations: the triangle technique", Can Fam Physician, 52, pp.1403~1404 (2006)
- Hermans J, "The most accurate approach for intra-articular needle placement in the knee joint : a systematic review", Semin Arthritis Rheum, 41, pp.106~115 (2011)
- Jackson DW, "Accuracy of needle placement into the intra-articular space of the knee", J Bone Joint Surg Am, 84, pp.1522~1527 (2002)
- Moser T, "Anterior approach for knee arthrography : tolerance evaluation and comparison of two routes", Radiology, 246, pp.193~197 (2008)
- Myles PS, "The pain visual analog scale: is it linear or nonlinear?", Anesth Analg, 89, pp.1517~1520 (1999)
- Katz J, "Measurement of pain", Surg Clin North Am, 79, pp.231~252 (1999)
- Altman RD, "Intraarticular sodium hyaluronate(Hyalgan)in the treatment of patients with osteoarthritis of the knee : a randomized clinical trial : Hyalgan Study Group", J Rheumatol, 25, pp.2203~2212 (1998)
- Leopold SS, "Corticosteroid compared with hyaluronic acid injections for the treatment of osteoarthritis of the knee: a prospective, randomized trial", J Bone Joint Surg Am, 85, pp.1197~1203 (2003)
- Neustadt DH, "Intra-articular injections for osteoarthritis of the knee", Cleve Clin J Med, 73, pp.897~898 (2006)
- Schumacher HR, "Injectable corticosteroids in treatment of arthritis of the knee", Am J Med, 118, pp.1208~1214 (2005)
- Chavez-Chiang CE, "The highly accurate anteriolateral portal for injecting the knee", Sports Med Arthrosc Rehabil Ther Technol, 3, pp.6~ (2011)
- Sanchis-Alfonso V, "Neuroanatomic basis for pain in patellar tendinosis("jumper’s knee") : a neuroimmunohistochemical study", Am J Knee Surg, 14, pp.174~177 (2001)
- Shah KD, "Intra-articular hydrocortisone in osteo-arthrosis", Ann Rheum Dis, 26, pp.316~318 (1967)
- Sibbitt WL Jr, "Does ultrasound guidance improve the outcomes of arthrocentesis and corticosteroid injection of the knee?", Scand J Rheumatol, 41, pp.66~72 (2012)
- Sibbitt WL Jr, "A randomized controlled trial evaluating the cost-effectiveness of sonographic guidance for intra-articular injection of the osteoarthritic knee", J Clin Rheumatol, 17, pp.409~415 (2011)
- Maricar N, "Where and how to inject the knee : a systematic review", Semin Arthritis Rheum, 43, pp.195~203 (2013)