Ultrasound guided injection of a painful knee osteoarthritis with medial meniscus extrusion: a case series study

Luca Di Sante, Teresa Venditto, Francesco Ioppolo, Marco Paoloni, Massimiliano Mangone, Federica Alviti, Luca Di Sante, Teresa Venditto, Francesco Ioppolo, Marco Paoloni, Massimiliano Mangone, Federica Alviti

Abstract

Background: Meniscal subluxation results in the natural history of knee osteoarthritis (OA). Periarticular infiltration should minimize possible complications related to penetration of corticosteroids into the joint space in the treatment of knee OA.According to pain relief and improvement of function, the aim of this study is to evaluate the effectiveness of perimeniscal corticosteroid ultrasound guided injection in knee OA.

Methods: Thirty-two patients received an injection of 0.5 ml of methylprednisolone-acetate around perimeniscal tissues. Outcome measures were pain relief and knee function, assessed by Visual Analogue Scale (VAS) [24, 29, 30] measured at rest (VAS-R) and during stairs climbing (VAS-C) and by Italian-Western Ontario and McMaster Universities (WOMAC) scale. Clinical evaluation was performed at baseline, at 1 and 4 weeks of follow-up.

Results: Mean baseline values of VAS-R and VAS-C were 6.79 ± 1.17 and 7.6 ± 1.39, respectively. All subjects showed a significant reduction in pain over time (p<0.001). Mean baseline values of WOMAC pain, stiffness and physical function were 5.56 ± 1.32, 4.39 ± 1.91 and 4.63 ± 2.31, respectively. According to WOMAC stiffness and physical function was not found a significant improvement over time (p> 0.05).

Conclusion: Corticosteroid perimeniscal ultrasound guided injection can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with knee OA.

Level of evidence: IV.

Keywords: corticosteroid injection; knee osteoarthritis; medial meniscal pain; pain; ultrasound guided injection.

Conflict of interest statement

Conflict of interests We are able to declare that there are no financial or other relationships that might lead to a conflict of interests and that no part of this work has been previously published.

Figures

Figure 1, Video 1. Methylprednisolone acetate ultrasound…
Figure 1, Video 1. Methylprednisolone acetate ultrasound guided injection
The transducer was aligned with the long axis of the tibio-femoral bone across articular line. By a freehand technique, a 22-gauge (4 cm) needle was then advanced under direct sonographic guidance into the anterior medial meniscus wall. Once the needle touched the medial meniscus wall it was retracted by 1 mm and an injection of 0.5 ml of methylprednisolone acetate around perimeniscal tissues was performed. Length: 32 seconds; Size: 3 MB.
Figure 2 a, b
Figure 2 a, b
a) Mean change of VAS score at rest over time. b) Mean change of VAS motion score over time.
Figure 3
Figure 3
Mean change of WOMAC pain score over time.

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