The following is a summary of “Measuring success: A comparison of ultrasound and landmark guidance for knee arthrocentesis in a cadaver model,” published in the September 2023 issue of Emergency Medicine by Shah, et al.

For a study, researchers sought to assess the procedural success of knee arthrocentesis without bone contact, comparing the use of landmark (LM) and ultrasound (US) guidance. The primary focus was on obtaining synovial fluid, with secondary considerations including the number of attempts, occurrences of accidental bone contact, time to aspiration, and overall procedural confidence.

This research, conducted as a randomized crossover study at a single academic center, compared the effectiveness of US-guided versus LM-guided knee arthrocentesis. Volunteers were randomly assigned to perform both techniques on cadavers. The primary outcome measure was procedural success, defined as the successful aspiration of synovial fluid on the first attempt without bone contact. Secondary outcomes encompassed the number of attempts, instances of bone contact, time taken for aspiration, and participants’ confidence levels.

A total of 61 participants completed the study, performing 122 procedures. Procedural success without bone contact was significantly higher in the US-guided group compared to LM (84% vs. 64%, P = 0.02). Although the time to aspiration was longer for the US group (38.75 s vs. 25.54 s, P = 0.004), participants expressed greater confidence in the US technique both before the procedure (29 vs. 21, P = 0.03) and after the procedure (83 vs. 69, P = 0.0001). Participants experienced a more substantial increase in confidence with US guidance following training (44 vs. 26, P = 0.01).

The study concluded that US guidance in knee arthrocentesis resulted in a higher rate of procedural success without bone contact. Additionally, participants exhibited increased confidence in the US technique, suggesting its potential benefits in providing better needle control and avoiding sensitive structures during the procedure.

Source: sciencedirect.com/science/article/abs/pii/S073567572300339X