Efficacy of knee joint aspiration in patients with acute ACL injury in the emergency department.
OBJECTIVE
To evaluate the influence of joint aspiration on the sensitivity of physical examination for diagnosing acute anterior cruciate ligament (ACL) lesion in the second outpatient-department (OPD) follow-up referred from emergency department (ED).


METHODS
This retrospective study included sixty patients underwent ACL reconstruction with initial visit at ED. They were divided into two groups based on the presence or absence of joint aspiration at ED. All participants were referred to second OPD follow-up within 7-14days after the injury. Clinical manifestation (including visual analogue scale (VAS) for pain, range of motion (ROM), and severity of knee effusion) and physical examination (Lachman test and pivot shift test) were checked in ED and the second OPD follow-up.


RESULTS
The group of patients with joint aspiration (G1) showed substantial decreases in mean values of VAS for pain (p=0.005), ROM (p=0.001), and effusion level (p<0.001), even higher VAS and effusion level and lower ROM at the initial visit of ED than the other group (G2). The sensitivity of positive Lachman and pivot shift test was significantly (p<0.05) increased following knee joint aspiration. Positive Lachman test was recorded at 76.5% in the second follow-up in G1, which was significantly (p=0.047) higher than that (47.6%) in G2. The percentage of positive pivot shift test was recorded at 76.5% in the second follow-up in G1, which as significantly (p<0.001) higher than that (31.0%) in G2.


CONCLUSIONS
Knee joint aspiration in acute ACL injury with suspected hemarthrosis could be considered as a diagnostic procedure. Joint aspiration in early medical attendance might be able to lower pain scores or raise the sensitivity of physical examination for diagnosing acute ACL injury at follow up visit in orthopedic outpatient department.


METHODS
Retrospective cohort study III.
Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea. Electronic address: mdwang88@gmail.com.
Joon Ho
JH
Wang
Department of Emergency Medicine, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea. Electronic address: saber99@naver.com.
Jin Hyuck
JH
Lee
Department of Emergency Medicine, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea. Electronic address: faith2love@hanmail.net.
Youngsuk
Y
Cho
Hanyang University School of Medicine, Seoul, South Korea. Electronic address: neo41286@naver.com.
Jung Min
JM
Shin
Department of Orthopaedic Surgery Kang-Dong Sacred Heart Hospital, Hallym University Medical School, Gil-dong, Seoul 134-701, South Korea. Electronic address: oselite@naver.com.
Byung Hoon
BH
Lee
D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006395:Hemarthrosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D010147:Pain Measurement; D010808:Physical Examination; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D012017:Referral and Consultation; D012189:Retrospective Studies; D013396:Suction / Q000379:methods*; D016896:Treatment Outcome
Anterior cruciate ligament; Emergency department; Hemarthrosis; Physical examination. joint aspiration