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When performing an aspiration or intra-articular injection in the knee, the most accurate needle placement site is which of the following?
At the site of maximal tenderness
Medial to patellar tendon with knee flexed
Lateral to patellar tendon with knee flexed
Medial to proximal patella with knee in extension
Lateral to the patella with knee in extension
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Intra-articular administration of medications has been shown to be highest with the injection performed lateral to the middle to proximal patella with the knee in extension. Extension allows greater patellar mobility and increases the available space in the patellofemoral joint compared to flexion. A lateral starting point when injecting into the patellofemoral joint has less overlying soft tissue than medial, which makes it easier to palpate the bony landmarks and evert the patella.
Jackson et al. evaluated 240 consecutive injections in patients without clinical knee effusion placed anteromedial, anterolateral, or lateral midpatellar. Using fluoroscopy to confirm location, accuracy rates were highest for the midlateral portal (93%) compared to anteromedial (75%) or anterolateral (71%).
Jackson DW, Evans NA, Thomas BM
J Bone Joint Surg Am. 2002 Sep;84-A(9):1522-7. PMID: 12208907 (Link to Abstract)
Jackson, JBJS 2002
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HPI - recurrent swelling of the knee + pain on exercises ..
what is the diagnosis ??
vascular form of PVNS ?? hemangioma ?? benign vascular tumor ?? marker of a haemophilia?