Anterior Approach for Knee Arthrography: Tolerance Evaluation and Comparison of Two Routes

Abstract

To prospectively evaluate patient tolerance and technical success of the anterior knee puncture approach for arthrography by using two different routes. The study had Strasbourg University Hospital review board approval. Informed consent was obtained from all patients (and from their parents, if patients were minors). In 159 patients (89 male and 70 female; age range, 14-82 years; mean age, 44.3 years +/- 16 [standard deviation]) referred for computed tomographic (CT) arthrography, anterior puncture of the knee was performed by using an anterolateral (n = 73) or anterior paramedian (n = 86) route. For each patient, body mass index, absolute pain on a visual analog scale, relative pain (compared with anticipatory pain), and history of previous knee arthrography were recorded. A score reflecting the technical success of the procedure was established by using a five-point scale. Factors influencing tolerance and technical success were analyzed with Pearson correlation coefficients. Student t and chi2 tests were used to compare the two routes. The anterior approach for knee arthrography was well tolerated (mean visual analog scale score, 12.9 +/- 16.4) and technically successful (mean technical success score, 1.36 +/- 0.84) in most cases. Absolute pain was not influenced by age, sex, or body mass index and was only weakly correlated (r = 0.33) with the technical success score. The technical success score weakly correlated (r = 0.23) with the body mass index. A slight but significant reduction in absolute (P < .05) and relative (P < .01) pain was observed for the anterolateral route compared with the anterior paramedian route, while no significant differences (P > .05) were found for other parameters, including the technical success score. The anterior approach for knee arthrography is technically successful and well tolerated, particularly when an anterolateral route is used.