Ultrasound-guided versus landmark in knee arthrocentesis: A systematic review

ObjectivesThe objective was to assess the efficacy of ultrasound-guided (USG) versus landmark (LM) knee arthrocentesis in adults with knee pain or effusion.MethodsA systematic review of the literature was performed until August 2015. All controlled trials reporting the accuracy or clinical efficacy between USG and LM knee joint arthrocentesis were selected. Pooled weighted mean difference (WMD) using the D-L fixed models for continuous outcomes and the risk ratio (RR) for dichotomous outcomes were assessed by meta-analysis. Heterogeneity between studies was estimated by I2 statistic.ResultsNine studies including 715 adult patients (725 knee joints) were eligible for this review versus LM group; there was a statistically significant difference in favor of USG for knee arthrocentesis accuracy rate (risk ratio = 1.21; 95% CI: 1.13-1.29; P < 0.001; I2 = 37%), lower procedural pain scores (WMD = −2.24; 95% CI: −2.92 to −1.56; P < 0.001; I2 = 4%), more aspiration volume (WMD = 17.06; 95% CI: 5.98-28.13; P = 0.003; I2 = 57%), and decreased pain score 2 weeks after injection (WMD = 0.84; 95% CI: 0.42-1.27; P < 0.001; I2 = 0). There was no statistically significant difference in procedural duration between two groups (WMD = −0.8; 95% CI: −2.24 to 0.74; P = 0.31; I2 = 0).ConclusionsUltrasound-guided knee joint arthrocentesis offer a significantly greater accuracy and clinical improvement over landmark technique in adults with knee pain or joint effusion.