Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Modified Bent Knee Approach for Highly Accurate Injection of the Knee.

Delea1,  Suzanne, Sibbitt3,  Wilmer L., Band,  Philip, Chavez-Chiang2,  Natalia, Norton2,  Hillary, Bankhurst4,  Arthur D.

University of New Mexico, Albuquerque, NM
University of New Mexico
University of New Mexico HSC, Albuquerque, NM
University of NM Med Ctr, Albuquerque, NM


The extended knee lateral midpatellar portal for 1 intraarticular injection of the knee is accurate but is not practical for all patients.


We hypothesized that a highly accurate modified anteriolateral portal where the synovial membrane of the medial femoral condyle is the target would be effective for intraarticular injection of the knee.

Study Design:

Randomized controlled clinical trial. Level 1.


83 subjects with "dry" non-effusive osteoarthritis of the knee were randomized to intraarticular injection using the modified anteriolateral bent knee versus the standard lateral midpatellar portal. 80 mg of triamcinolone acetonide was injected into the knee using a 2.0-in (5.1-cm) 21-gauge needle on a RPD procedure syringe (reciprocating procedure device) using the one-needle two-syringe technique. Baseline pain, procedural pain, and pain at outcome (2 weeks and 6 months) were determined with the 0–10 cm Visual Analogue Pain Score (VAS).The accuracy of needle placement was determined by sonographic imaging with provocative testing.


The lateral midpatellar and modified anteriolateral portals resulted in similar levels of procedural pain (VAS midpatellar: 4.6±3.1 cm; anteriolateral: 4.8±3.2 cm; p =0.77), pain at 2 weeks (VAS midpatellar: 2.6±2.8 cm; anteriolateral: 1.7±2.3 cm; p= 0.11), pain at 6 months (VAS midpatellar: 4.9±3.1 cm; anteriolateral: 4.8±3.2 cm; p =0.89), responders (midpatellar: 45.0%; anteriolateral: 55.8%; p=0.33), non-responders (midpatellar: 55.0%; anteriolateral: 44.2%; p =0.33), duration of therapeutic effect (midpatellar: 3.9±2.4 months; anteriolateral: 4.1±2.2 months; p=0.69), time to next procedure (midpatellar: 7.3±3.3 months; anteriolateral: 7.7±3.7 months; p=0.71), and cost per year (midpatellar: $243±110; anteriolateral: $231±111; p= 0.61). The bent knee anteriolateral portal was 97.4% accurate.

Conclusions and Clinical Relevance:

The modified anteriolateral 1 bent knee portal is an effective and accurate alternative to the standard lateral midpatellar portal for intraarticular injection of the knee, and results in equivalent levels of responders, pain reduction, costs, and duration of therapeutic effect.

To cite this abstract, please use the following information:
Delea, Suzanne, Sibbitt, Wilmer L., Band, Philip, Chavez-Chiang, Natalia, Norton, Hillary, Bankhurst, Arthur D.; Modified Bent Knee Approach for Highly Accurate Injection of the Knee. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :947
DOI: 10.1002/art.28715

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