title: Anterolateral Portal Is Less Painful than Superolateral Portal in Knee Intra-Articular Injection.
abstract: OBJECTIVE
  Intra-articular knee injections are commonly performed in clinical practice for treating various knee joint disorders such as osteoarthritis and rheumatoid arthritis. When selecting the portal for injection, not only intra-articular needle accuracy but also procedural pain should be taken into consideration. The purpose of this study was to determine whether injection through anterolateral portal provokes less pain and provides better pain relief compared to superolateral portal.
  
  
  METHODS
  A total of 60 patients with primary osteoarthritis of the knee receiving intra-articular injections were randomized into 2 groups according to the type of portal approach; anterolateral or superolateral. All patients received hyaluronic acid (20 mg) and triamcinolone (40 mg) as the first injection followed by second and third injections of hyaluronic acid on a weekly basis. Underlying knee pain, procedural pain, and knee pain at 4 weeks were evaluated using visual analogue scale (VAS).
  
  
  RESULTS
  Injection through anterolateral portal provoked less pain (VAS, 1.5±1.3) than the superolateral portal (VAS, 1.5 vs. 2.7; p=0.004). No differences were found in the degree of pain relief at weeks between the two groups (p=0.517).
  
  
  CONCLUSIONS
  We recommend the use of anterolateral portal for intra-articular knee injection as it provokes less pain and comparably short-term pain relief than the superolateral portal.
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Sung Yup
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Kiran Kumar
authors.initials: KK
authors.lastname: Gn
authors.affiliation: Joint Reconstruction Center, Knee and Spine Hospital, Seoul, Korea.
authors.forename: Byung June
authors.initials: BJ
authors.lastname: Chung
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Sang Wook
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Tae Kyun
authors.initials: TK
authors.lastname: Kim
keywords: Intra-articular injection; Knee; Osteoarthritis