Abstract
Ultrasound guided (USG) supra patellarbursa (SPB)knee aspirations-injections are a current standard practice, typically performed with the patient supine on a plinth, and with the knee flexedto around 30 degrees. This follows research that 30 degrees of knee flexion offers optimal SPB bursal resolution. However,in circumstances of pain-mobility issues affecting plinth transfer, an alternative seated, foot on floor or wheelchair pedal, knee-flexed 90 degrees procedure (SKIF)is proposed. This foot on floor position may facilitate a push-off counter resistance, facilitatingisometric quadriceps contraction enhanced suprapatellar bursa (SPB) viewing, along with improved resolution of thelesser describedmedial-lateral parapatellarbursae(MPPB-LPPB) and their communicating SPB recess channels. As the MPPB-LPPB interconnect to the medial-lateral SPB recesses but are located more superficially and centrifugal to the femoral condyles in areas devoid of underlying articular cartilage, their preferential SKIFinjection-aspiration,mayalso prevent cartilage needle stick injuries.alsoknown as the paracondylar gutters, the relatively superficial MPPB-LPPB position may likewise offer better image resolution, lessenneedle travel distances and needle trajectory re-directs, which may in turn enhance procedure safety, comfort, and speed. Though the medial-lateral SPB recesses have some mention in the literature, it would appear thatinter tri-bursal connecting channels linking the MPPB-LBBP to the SPB recesses have not previously been described.This report explores tri-bursal and inter-bursal channel anatomy, relevant to performing USG SKIF injections and also elucidates the method, potential advantages, and pitfalls of this novel technique.
Highlights
A bursa is a fluid-filled structure that is present between the skin and tendon or tendon and bone
This paper explores the tri-bursal and inter-bursal channel anatomy relevant to SKIF Ultrasound guided (USG) injection
Failure of regression of the transverse septum formed in embryonic life between the suprapatellar plica and the knee joint fluid leads to the formation of the suprapatellar bursa (SPB)
Summary
A bursa is a fluid-filled structure that is present between the skin and tendon or tendon and bone. [3] Ultrasound guided (USG) supra patellar bursa (SPB) knee aspirations-injections are a current standard practice, typically performed with the patient supine on a plinth, with the knee flexed to around 30 degrees and a transverse transducer position. This follows research that 30 degrees of knee flexion offers optimal SPB bursal resolution. In this study SPB, fluid was evaluated in the sagittal rather than transverse plane [4] Other studies have noted that quadriceps isometric voluntary contraction enhances tri-bursal visibility, and surface EMG bench push-off studies have reported that quadriceps isometric contraction overall occurs maximally at 90 degrees knee flexion. In this study SPB, fluid was evaluated in the sagittal rather than transverse plane [4] Other studies have noted that quadriceps isometric voluntary contraction enhances tri-bursal visibility, and surface EMG bench push-off studies have reported that quadriceps isometric contraction overall occurs maximally at 90 degrees knee flexion. [5]
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