Knee Arthrocentesis

Alicia Blazejewski

INDICATIONS

 Used to evacuate abnormal fluid collections from the joint space for synovial fluid analysis

    Septic arthritis

    Crystal arthropathy

    Hemarthrosis

    Inflammatory process

 Used to diagnose occult fracture or ligamentous injury

 Used to decrease/relieve pressure in the joint to provide pain relief

 Used to inject methylene blue and test for joint capsule integrity when concerned that overlying laceration communicates with joint space

 Used to inject medication for treatment and pain relief

CONTRAINDICATIONS

 Absolute Contraindications

    Abscess/cellulitis in the tissue overlying the site to be punctured (often infectious arthritis can mimic an overlying soft-tissue infection)

 Relative Contraindications

    Bleeding diatheses/anticoagulant therapy

    Prosthetic joint

    Known bacteremia

RISKS/CONSENT ISSUES

 Potential for introducing infection (sterile technique must be utilized)

 Procedure can cause pain (local anesthesia will be given)

 Needle puncture can cause localized bleeding

 Reaccumulation of fluid may occur

 Risk of injuring articular cartilage with needle tip

LANDMARKS

 Parapatellar Approach

    Can use medial or lateral approach

    Enter 1 cm from the edge of the patella along the superior one-third of the medial or lateral border

    Direct the needle along the inferior surface of the patella and toward the intercondylar notch (FIGURE 55.1)

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