Ultrasound evaluation of fluid in knee recesses at varying degrees of flexion.
OBJECTIVE
Various methods are utilized in daily practice to obtain optimal information on effusion in the knee. Our aim is to investigate which scanning position provides the best information about synovial fluid in the knee by using ultrasound and to evaluate the magnitude of difference for measuring synovial fluid in 3 major recesses (suprapatellar, medial parapatellar, and lateral parapatellar) of the knee according to various degrees of flexion.


METHODS
Sonographers in 14 European centers documented bilateral knee joint ultrasound examinations on a total of 148 knee joints. The largest sagittal diameter of fluid was measured in scans corresponding to the 3 major recesses at different (0°, 15°, 30°, 45°, 60°, and 90°) degrees of flexion of the knee. The difference of measurement of effusion according to transducer position, knee position, and the interaction between them was investigated by analysis of variance followed by Tukey's test.


RESULTS
No correlation was noted between patient characteristics and ultrasound detection of effusion. The sagittal diameter of synovial fluid in all 3 recesses was greatest at 30° flexion. Analysis of variance and Tukey's test revealed that the suprapatellar scan and 30° flexion is the best combination for detecting effusion as confirmed by receiver operator characteristic curve analysis.


CONCLUSIONS
The suprapatellar scan of the knee in 30° flexion was the most sensitive position to detect fluid in knee joints. Sagittal diameter of fluid in all 3 recesses increased with the knee in the 30° flexed position as compared to the extended position.
Division of Rheumatology, Medical University of Vienna, 18-20 Währinger Gürtel, Vienna, Austria. mandlpeter@yahoo.com
P
P
Mandl
M
M
Brossard
P
P
Aegerter
M
M
Backhaus
G A
GA
Bruyn
I
I
Chary-Valckenaere
A
A
Iagnocco
E
E
Filippucci
J
J
Freeston
F
F
Gandjbakhch
S
S
Jousse-Joulin
I
I
Möller
E
E
Naredo
W A
WA
Schmidt
M
M
Szkudlarek
L
L
Terslev
R J
RJ
Wakefield
A
A
Zayat
M A
MA
D'Agostino
P V
PV
Balint
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D038622:Internationality; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D013582:Synovial Fluid / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D055815:Young Adult