Aspiration and injection of the knee joint is a commonly performed medical procedure. Injection of corticosteroid for the treatment of osteoarthritis is the most common reason for knee joint injection, and is performed as an office procedure. Debate exists among practitioners as to the 'best' approach portal for knee injection. This paper examines the various approach portals for injection and/or aspiration of the knee joint, as well as the accuracy of each approach. Searches were made of electronic databases, and appropriate papers were identified and hand-searched. Although there is some evidence that particular approach portals may be more efficacious in the presence of specific knee joint pathologies, generally, in experienced hands, it is of no clinical consequence as to which approach portal is utilised for aspiration or injection of the knee joint. No approach portal is 100% accurate, and the accuracy of injection of the knee joint may be enhanced by the use of techniques such as ultrasound. Practitioners are reminded that they should continuously refine and practice their preferred technique. Knee joint aspiration and injection is a common, simple, and generally safe office procedure.
Hand ; Knee Joint ; Knee ; Osteoarthritis ; Pathology ; Ultrasonography

A sixty-eight-year-old female presented with suddenly developed pain in the left knee joint. On the first visit, there was severe tenderness on the anterolateral aspect of the knee joint with active flexion and extension limited by pain. Radiographs revealed multiple round calcific masses in the anterolateral aspect of the knee joint. Under the impression of intraarticular lesions, we performed arthroscopic examination of the knee joint, which revealed no intraarticular pathology. The masses were found in the extracapsular soft tissue and we performed excisional biopsy of the masses completely. The masses were confirmed as tumoral calcinosis by histopathologic examination. It rarely occurs around the knee joint and is usually asymptomatic. Idiopathic tumoral calcinosis with acute symptoms must be differentiated from other pathologic conditions such as gout or infection. The clinical manifestation of this case was opposed to the previous reports. So we report a rare case of idiopathic tumoral calcinosis of the knee joint with acute symptoms.
Biopsy ; Calcinosis* ; Female ; Gout ; Humans ; Knee Joint* ; Knee* ; Pathology

PURPOSE: The purpose of this study was to investigate the impact of varying knee flexion and quadriceps activity on patellofemoral indices measured on magnetic resonance imaging (MRI). MATERIALS AND METHODS: MRI of the knee was performed in 20 patients for indications other than patellar or patellofemoral pathology. Axial and sagittal sequences were performed in full extension of the knee with the quadriceps relaxed, full extension of the knee with the quadriceps contracted, 30° flexion of the knee with the quadriceps relaxed, and 30° flexion with the quadriceps contracted. Bisect offset, patella tilt angle, Insall-Salvati ratio and Caton-Deschamps index were measured. RESULTS: With the knee flexed to 30° and quadriceps relaxed, the mean values of patellar tilt angle, bisect offset, Insall-Salvati ratio and Caton-Deschamps index were all within normal limits. With the knee extended and quadriceps contracted, the mean patellar tilt angle (normal value, <15°) was 14.6° and the bisect offset (normal value, <65%) was 65%, while the Caton-Deschamps index was 1.34 (normal range, 0.6 to 1.3). With the knee extended and quadriceps relaxed, the mean Caton-Deschamps index was 1.31. CONCLUSIONS: MRI scanning of the knee in extension with the quadriceps contracted leads to elevated patellofemoral indices. MRI taken with the knee in 30° of flexion allows more reliable assessment of the patellofemoral joint and minimises the confounding effect of quadriceps contraction.
Humans ; Knee ; Magnetic Resonance Imaging ; Patella ; Patellofemoral Joint ; Pathology

OBJECTIVETo investigate clinical characteristics and pathological changes of tissue surrounding prosthesis after hip and knee arthroplasty.

METHODSA total of 67 patients receiving hip and knee arthroplasty were included in the study and pathological changes of the revision specimens were evaluated by microscopic examination.

RESULTSOf 67 patients, there were 25 males and 42 females (ratio of 0.6) with a mean age of 64 years. There were 42 cases of revision hip prosthesis and 25 cases of knee prosthesis. The primary causes for the revision varied, including 20 cases of infection (29.9%, within 3 months in 9 cases,3 to 24 months in 3 cases and over 24 months in 8 cases), 14 cases of pain (20.9%), 13 cases of loosening of the prosthesis (19:4%), 9 cases of joint stiffness (13.4%), 8 cases of prosthetic dislocation (11.9%), and 3 cases of prosthesis fracture (4.5%). Pathological findings in the tissue surrounding the prostheses included debris reaction, histiocytes, acute inflammatory, chronic non-specific inflammation, pigmented villonodular synovitis (PVNS), "pseudomembranous", calcification, necrosis, sequestrum, etc. These histological changes were frequently admixed.

CONCLUSIONSVarious reasons may lead to hip and knee revision arthroplasty. The main pathological findings include infection, debris granulomas, chronic non-specific inflammatory changes, PVNS. The surgical pathology of the prosthesis provids guidances for clinical treatment and basic research.

Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Female ; Hip Joint ; pathology ; Humans ; Knee Joint ; pathology ; Knee Prosthesis ; Male ; Middle Aged ; Reoperation ; Synovitis, Pigmented Villonodular ; pathology

Magnetization Transfer (MT) imaging generates contrast dependent on the phenomenon of magnetization exchange between free water proton and restricted proton in macromolecules. In biological materials in knee, MT or cross-relaxation is commonly modeled using two spin pools identified by their different T2 relaxation times. Two models for cross-relaxation emphasize the role of proton chemical exchange between protons of water and exchangeable protons on macromolecules, as well as through dipole-dipole interaction between the water and macromolecule protons. The most essential tool in medical image manipulation is the ability to adjust the contrast and intensity. Thus, it is desirable to adjust the contrast and intensity of an image interactively in the real time. The proton density (PD) and T2-weighted SE MR images allow the depiction of knee structures and can demonstrate defects and gross morphologic changes. The PD- and T2-weighted images also show the cartilage internal pathology due to the more intermediate signal of the knee joint in these sequences. Suppression of fat extends the dynamic range of tissue contrast, removes chemical shift artifacts, and decreases motion-related ghost artifacts. Like fat saturation, phase sensitive methods are also based on the difference in precession frequencies of water and fat. In this study, phase sensitive methods look at the phase difference that is accumulated in time as a result of Larmor frequency differences rather than using this difference directly. Although how MT work was given with clinical evidence that leads to quantitative model for MT in tissues, the mathematical formalism used to describe the MT effect applies to explaining to evaluate knee disorder, such as anterior cruciate ligament (ACL) tear and meniscal tear. Calculation of the effect of the effect of the MT saturation is given in the magnetization transfer ratio (MTR) which is a quantitative measure of the relative decrease in signal intensity due to the MT pulse.
Anterior Cruciate Ligament ; Artifacts ; Cartilage ; Knee Joint ; Knee* ; Pathology ; Protons ; Relaxation ; Water

PURPOSE: We assessed the clinical outcome of contralateral arthroscopic meniscectomy performed with unilateral total knee arthroplasty (TKA). MATERIALS AND METHODS: From May 1999 to June 2006, 23 patients underwent unilateral total knee arthroplasty and contralateral arthroscopic meniscectomy at the same time. All patients were women and followed for at least 36 months, except 2 patients who died. For clinical assessment, range of motion of the knee joint, Hospital for Special Surgery (HSS) knee score and the Lysholm knee score were evaluated preoperatively and at the last follow-up. At arthroscopy, meniscal pathology and cartilage changes were recorded and classified according to the Outerbridge scale. Progression of osteoarthritis in the contralateral knee to subsequent TKA was also assessed. RESULTS: The mean age of the 21 patients was 67.1 years and the mean follow-up period was 5.7 years. All of the patients were diagnosed with osteoarthritis and had Outerbridge grade 3 or 4 cartilage changes. Eight of the 21 patients had subsequent TKA at an average of 3.1 years after the index operation. The other 13 patients had no further surgery and clinical results including the HSS knee score and the Lysholm score were improved from 74.5 and 60.6 preoperatively to 90.8 and 82.4 postoperatively, respectively (p<0.001). CONCLUSIONS: Contralateral arthroscopic meniscectomy performed simultaneously with unilateral TKA produces relatively good results regardless of the presence of cartilage degeneration.
Arthroplasty ; Arthroscopy ; Cartilage ; Female ; Follow-Up Studies ; Humans ; Knee Joint ; Knee ; Osteoarthritis ; Pathology ; Range of Motion, Articular

PURPOSE: The purpose of this study was to report clinical results of open excision of extra-articular ganglion cysts around the knee joint combined with arthroscopic management of intra-articular pathologies if present. MATERIALS AND METHODS: Of the total 107 cases of cystic lesions around the knee, 23 cases of extra-articular ganglion cysts were reviewed between January 2006 and July 2011. There were 13 males and 10 females with a mean age of 48 years (range, 30 to 73 years). The mean follow-up duration was 40 months (range, 30 to 60 months). Preoperative magnetic resonance imaging (MRI) scan was done in all cases. Open surgical excision of the cyst was performed after arthroscopic management of intra-articular pathologies in all but 1 case. At the last follow-up, Lysholm and International Knee Documentation Committee (IKDC) scores were evaluated and MRI was conducted to detect recurrence. RESULTS: The mean Lysholm and IKDC scores showed significant improvement (p=0.005 and 0.013, respectively).The location of the cysts was anterior in 9, lateral in 7, medial in 6, and posterosuperior in 1. Intra-articular pathologies were found in 16/23 cases (69.6%). In 10/23 cases (43%), the cyst was connected to the knee joint. Three months postoperative MRI did not show any recurrence of ganglion cysts except for 1 case. CONCLUSIONS: In the treatment of extra-articular ganglion cysts, MRI can be useful for detecting intra-articular lesions and connecting orifices, and arthroscopic management of intra-articular pathologies with open excision of the cyst should be considered as a viable treatment option.
Female ; Follow-Up Studies ; Ganglion Cysts ; Humans ; Knee Joint ; Knee ; Magnetic Resonance Imaging ; Male ; Pathology ; Recurrence

PURPOSE: The pattern of symptoms of knee osteoarthritis has been thought to be indicative of specific compartment involvement. This study investigated whether there was a true correlation between patellofemoral joint (PFJ) symptoms and unicompartmental patellofemoral arthritis. MATERIALS AND METHODS: A prospective analysis of 34 patients rendered to be suffering from PFJ osteoarthritis and subsequently undergoing unicompartmental patellofemoral arthroplasty (PFA) was performed. A control cohort of 32 patients suffering from medial tibiofemoral joint (MTFJ) osteoarthritis was included in the analysis. Four questions derived from the Oxford knee score questionnaire, traditionally deemed to be indicative of PFJ osteoarthritis, were combined to create a PFJ subscore and statistically analyzed for their potential relationship with PFJ osteoarthritis and outcomes following PFA. RESULTS: The PFJ subscore indicated slightly worse pathology in patients undergoing PFA compared to MTFJ replacement, but the difference was not significant (9.7 and 9.6, respectively; p=0.851). The improvement in PFJ symptoms was higher in those undergoing PFA compared to MTFJ surgery; however, the difference was not statistically significant (3.7 and 2.2 respectively, p=0.074). CONCLUSIONS: We were unable to prove that these symptoms were predictive of PFJ pathology in the preoperative setting, nor were they useful in interpreting which symptoms would likely improve following PFA.
Arthritis ; Arthroplasty ; Cohort Studies ; Humans ; Joints ; Knee ; Osteoarthritis ; Osteoarthritis, Knee ; Patellofemoral Joint ; Pathology ; Prospective Studies

It is well known that double contrast knee arthrography is useful in diagnosis of meniscal lesions and other knee pathology, But intra-articular structures become less well delineated shortly after injection into the kneejoint with water soluble contrast media because of rapid absorption and dilution of the injected media. This limits the time when sharply detailed arthrograms are obtainable and precludes repeat delayed arthrogram withougreinjection of contrast media. In order to overcome this major disadvantage, the authors used epinephrine which has vasoconstrictive effect and is expected to reduce fluid movement across the synovial membrane temporarily. The authors attempted to compare epinephrine inhanced double contrast arthrographic group, einephrine(+) group, to thedouble contrast arthrographic group withoug epinephrine, epinephrine(-) group, by statistical evaluation. Eachgroup consisted of 35 cases and 7 lateral films of knee joint were taken sequentially 2,6,10,15,10,20,30, and 60 minutes after injection of contrast media, and were assessed by 5 certified radiologists. The resuls were as follows; 1. The difference of mean score of quality between epinephrine(+) group and epinephrine(-) group was statistically significant at every time interval (p value<0.01 at 2 minutes, p<0.01 at all other time intervals).Epinephrine(+) group was superior to the epinephrine(-) group in quality of film. 2. Numbers of cases above scoreof 2 which was considered to be of diagnostic quality in evaluating meniscal lesions were larger in epinephrine(+)group than epinephrine(-) group in quality of film. 3. Only 43% of cases was above score of 2 at 10 minutes inepinephrine (-) group, but 97% at 10 minutes and 80% at 20 minutes respectively in epinephrine(+) group. Therefore duration for adequate study of arthrogram is prolonged more than two times in epinephrine(+) group. 4. At 30 minuts, 57% of cases was above score of 2 in epinephrine(+) group while at 15 minuts, 80% of cases was below scoreof 2 in epinephrine(-) group. This makes it possible to repeat study without additional injection of contrast media or postponing of the examination in half of cases, if necessary. 5. The use of epinephrine in kneearthrography results in significant enhancement of radiographic quality initially (p<0.01). Therefore we can fluoroscope in good condition and obtain films of fine quality.
Absorption ; Arthrography ; Contrast Media ; Diagnosis ; Epinephrine ; Knee Joint ; Knee ; Pathology ; Synovial Membrane ; Water

Diagnosis of knee jont pathology has been mainly dependent on clinical manifestations and invasive proceduressuch as arthrography and arthroscopy etc. However, these procedures are invasive. Arthroscopy is perfromed undergeneral anesthesia. Recently, with development of high resuloution CT with thin slices and multiplanarreconstructions capability, CT could be used to verify the internal structures of knee joint in noninvasive orless invasive way. From June ot December 1985, authors have experienced 19 cases of the knee joint CT. Among them,13 cases were operated and confirmed. We concluded as follows. 1. The diagnostic accuracy of the knee CT was 100%in lateral meniscal tearing, 92.3% in medial meniscal tearing, 92.3% in detachment of lateral collateral ligament,92.3% in medial collateral ligament, 100% in tearing of cruciate ligaments. 2. CT could be considered as a primarydiagnostic procedure in the knee pathology rather than more invasive arthrocopy or arthrography. 3. For theaccurate diagnosis of knee joint pathology, CT which can obtain thin slies, high resolution, multiplanarreconstructions is indispensable.
Anesthesia ; Arthrography ; Arthroscopy ; Collateral Ligaments ; Diagnosis ; Knee Joint ; Knee ; Ligaments ; Pathology ; Tears