Knee Joint Injection

Other Names

• Knee Injection

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Background

• This page refers to injections of the knee joint
  • Knee Arthrocentesis is discussed separately

Anatomy

• Knee Joint
  • Formed by the articulation of the distal femur, proximal tibia
  • Multiple significant static and dynamic stabilizers
  • Suprapatellar recess communicates directly with the joint

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Indications

• Knee Arthritis

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Contraindications

• Absolute
  • Anaphylaxis to injectates
  • Overlying cellulitis, skin lesion or systemic infection
• Relative
  • Can be treated with less invasive means
  • Tendon tear or rupture
  • Hyperglycemia or poorly controlled diabetes
  • Lack of symptom improvement with previous injection

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Procedure

Equipment

• Sterile including chloraprep, chlorhexadine, iodine
• Ultrasound with sterile probe cover
• Gloves
• Needle: typically 21-23 gauge, 1-1.5 inch
• Syringe: 5-10 mL
• Gauze
• Ethyl Chloride
• Bandage
• Injectate
  • Local anesthetic, Corticosteroid etc

Preparation

• Place ultrasound on opposite side of patient
• Identify sonographic landmarks

Palpation Guided Technique

• Position: the patient is seated, legs hanging off the examination table
• Landmarks
  • The lateral compartment approach is the simplest and easiest
  • Identify the lateral tibial plateau, femoral condyle and lateral border of the patella tendon
  • Mark the skin just laterally to the tendon between the femur and tibia
  • Note: the same landmarks can be used to enter from the medial joint space
• Sterilize the skin
• Provide cutaneous anesthesia as indicated
  • Ethyl chloride is typically sufficient
• Injection
  • Prior to injection, use your knees to stabilize the patients leg so they do not flinch
  • Needle and syringe should be roughly parallel to the ground
  • Needle vector should be directed into the popliteal fossa
  • Advance needle approximately 1 inch into joint space, redirection may be required
  • Aspirate to ensure no blood return, then inject
  • Inject and if meeting resistance, pull back needle slowly until injection flows easily
• After procedure, apply pressure to tamponade any bleeding
• Apply bandage

Ultrasound Guided Technique

Short axis view of the suprapatellar recess with in-plane advancement of the needle tip.

• Position
  • Patient is supine
  • Hip and knee are in extension in a neutral position
• Ultrasound
  • Identify the suprapatellar recess in short axis using the linear probe
  • If no effusion is present, push on the suprapatellar tissue plane to identify the space
  • Mark your injection site on the skin
• Sterilize the skin and apply a probe cover
• Injection
  • Re-identify the suprapatellar recess with the ultrasound probe
  • Advance the needle into the suprapatellar recess
  • Note: you may need to use some sterile water or anesthetic to hydrodilate the recess
  • Once needle placement is confirmed, inject your other injectates
• After procedure, apply pressure to tamponade any bleeding
• Apply bandage

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Aftercare

• No major restrictions in most cases
• Can augment with ice, NSAIDS

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Complications

• Infection
• Damage to surrounding tissue

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See Also

• Procedures Main
• Ultrasound Main
• Ankle Pain Main

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