A vibration sensor approach to detect intra-articular needle tip placement in the knee joint: a proof-of-concept study

Rit Apinyankul,Kritsada Siriwattanasit,Weerachai Kosuwon,Kakanand Srungboonmee,Witchaporn Witayakom

doi:10.1186/s12891-021-04836-y

Rit Apinyankul, Kritsada Siriwattanasit + Show 3 more

Open Access

https://doi.org/10.1186/s12891-021-04836-y

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Abstract

BackgroundIntra-articular injection in the dry knee joint is technically challenging particularly for the beginners. The aim of this study was to investigate the possible use of the vibration sensor to detect if the needle tip was at the knee intra-articular position by characterizing the frequency component of the vibration signal during empty syringe air injection.MethodsTwo milliliters of air were injected supero-laterally at extra- and intra-articular positions of a cadaveric knee joint, using needles of size 18, 21 and 24 gauge (G). Ultrasonography was used to confirm the positions of needle tip. A piezoelectric accelerometer was mounted medially on the knee joint to collect the vibration signals which were analyzed to characterize the frequency components of the signals during injections.ResultsThe vibration frequency band power in the range of 500–1500 Hz was visually observed to potentially localize the needle tip placement during air injection whether they were at the knee extra-articular or intra-articular positions, as demonstrated by the higher band power (over − 40 dB or dB) for all the needle sizes. The differences of frequency band power between extra- and intra-articular positions were 18.1 dB, 26.4 dB and 39.2 dB for the needle size 18G, 21G and 24G respectively. The largest difference in spectral power was found in the smallest needle diameter (24G).ConclusionsA vibration sensor approach was preliminarily proved to distinguish the intra-articular from extra-articular needle placement in the knee joint. This study demonstrated a possible implementation of an alternative electronic device based on this technique to detect the intra-articular knee injection.

Highlights

Intra-articular injection in the dry knee joint is technically challenging for the beginners
Local anesthesia injection to the knee joint is done in the elective knee arthroscopy cases [1, 2] and in some knee physical examinations that need to be done
Higher power spectral density at the high frequency band was observed when the needle tips were in the knee intra-articular position, but not in the extra-articular position

Summary

Introduction

Intra-articular injection in the dry knee joint is technically challenging for the beginners. Intra-articular knee injection is a common procedure in treatment and diagnosis of the knee joint pathology. The accuracy of intra-articular needle placement is critical to prevent soft tissue complication and achieve a good treatment outcome by avoiding inadequate analgesia and agent concentration in the intra-articular space. To minimize potential complications of extra-articular injection from local tissue damage, such as atrophy of muscle and subcutaneous fat, pain, skin hypo-pigmentation [7] and skin necrosis [8], proper placement of needle is advocated to confirm intra-articular needle position [9]. In 90o-bended knee position, a study using squishing technique [12] and post-injection mini air-arthrography [13] demonstrates that injection with modified anterolateral approach has higher accuracy (89%) than the superolateral approach (58%) [14]

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