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How effective is a saline arthrogram for wounds around the knee?

ABSTRACT: UNLABELLED: Traumatic arthrotomies may predispose patients to subsequent septic arthritis and therefore are regarded as serious injuries requiring emergent treatment. The saline arthrogram is a commonly used test to determine if a patient has a traumatic arthrotomy. We determined the sensitivity of the saline arthrogram to identify known intraarticular wounds in 78 patients (80 knees) undergoing elective arthroscopic procedures. There were 66 infrapatellar and 14 suprapatellar incisions. The average length of the incision was 7.5 mm. Intraarticular position was confirmed with a blunt probe. A saline arthrogram then was performed using 60 mL normal saline. The known arthrotomy (operative wound) was observed during the injection for evidence of saline leakage (positive static test). If no leakage was observed, the knee was brought through a range of motion with continued observation for leakage from the arthrotomy (positive dynamic test). Twenty-two of 80 knees had a positive test without passive range of motion of the knee (static sensitivity, 36%). Eight additional knees had a positive test with subsequent passive motion (dynamic sensitivity, 43%). Our data suggest a saline arthrogram has low sensitivity for detecting known small traumatic arthrotomy wounds of the knee. LEVEL OF EVIDENCE: Level I, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

SUBMITTER: Tornetta P

PROVIDER: S-EPMC2505139 | biostudies-other | 2008 Feb

REPOSITORIES: biostudies-other

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Project description:Importance:Synovitis is common and is associated with progression of structural characteristics of knee osteoarthritis. Intra-articular corticosteroids could reduce cartilage damage associated with synovitis but might have adverse effects on cartilage and periarticular bone. Objective:To determine the effects of intra-articular injection of 40 mg of triamcinolone acetonide every 3 months on progression of cartilage loss and knee pain. Design, Setting, and Participants:Two-year, randomized, placebo-controlled, double-blind trial of intra-articular triamcinolone vs saline for symptomatic knee osteoarthritis with ultrasonic features of synovitis in 140 patients. Mixed-effects regression models with a random intercept were used to analyze the longitudinal repeated outcome measures. Patients fulfilling the American College of Rheumatology criteria for symptomatic knee osteoarthritis, Kellgren-Lawrence grades 2 or 3, were enrolled at Tufts Medical Center beginning February 11, 2013; all patients completed the study by January 1, 2015. Interventions:Intra-articular triamcinolone (n?=?70) or saline (n?=?70) every 12 weeks for 2 years. Main Outcomes and Measures:Annual knee magnetic resonance imaging for quantitative evaluation of cartilage volume (minimal clinically important difference not yet defined), and Western Ontario and McMaster Universities Osteoarthritis index collected every 3 months (Likert pain subscale range, 0 [no pain] to 20 [extreme pain]; minimal clinically important improvement, 3.94). Results:Among 140 randomized patients (mean age, 58 [SD, 8] years, 75 women [54%]), 119 (85%) completed the study. Intra-articular triamcinolone resulted in significantly greater cartilage volume loss than did saline for a mean change in index compartment cartilage thickness of -0.21 mm vs -0.10 mm (between-group difference, -0.11 mm; 95% CI, -0.20 to -0.03 mm); and no significant difference in pain (-1.2 vs -1.9; between-group difference, -0.6; 95% CI, -1.6 to 0.3). The saline group had 3 treatment-related adverse events compared with 5 in the triamcinolone group and had a small increase in hemoglobin A1c levels (between-group difference, -0.2%; 95% CI, -0.5% to -0.007%). Conclusions and Relevance:Among patients with symptomatic knee osteoarthritis, 2 years of intra-articular triamcinolone, compared with intra-articular saline, resulted in significantly greater cartilage volume loss and no significant difference in knee pain. These findings do not support this treatment for patients with symptomatic knee osteoarthritis. Trial Registration:ClinicalTrials.gov Identifier: NCT01230424.

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How effective is a saline arthrogram for wounds around the knee?

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