Abstract
Background
Traumatic arthrotomy of the knee (TAK) involves the violation of the knee capsule.
TAK differs from simple lacerations because it requires operative management to prevent
resultant septic arthritis. The diagnostic test of choice in the emergency department
is the saline load test (SLT). SLT sensitivity ranges from 34% to 99%, depending on
volume used. Computed tomography (CT) is a possible alternative, using intra-articular
air as a diagnostic marker. Ultrasound can identify air in various tissues, given
its highly echogenic nature.
Objective
We sought to determine the sensitivity and specificity of ultrasound for detecting
intra-articular air in cadaveric knee joints.
Methods
Soft embalmed cadavers were utilized. The knees were block randomized to having 1 mL
of air injected into the joint or sham skin injection. Two blinded, expert operators
scanned the knees with a high-frequency linear transducer. The sensitivity and specificity
were calculated.
Results
Twenty knees were included. Knees that had any prior dissection were excluded from
analysis. Ten knees were randomized for air injection. The pooled sensitivity was
0.65 (95% confidence interval [CI] 0.41–0.85) with a specificity of 0.75 (95% CI 0.48–0.93).
Mean time taken was 143 s.
Conclusions
Ultrasound may have utility in evaluation of TAK. There were limitations. Some knees
had effusions with echogenic material present, which could have led to false-positive
results. It is also unknown how much air is typical of TAK. One milliliter was used
based on previous work with CT. The use of ultrasound for diagnosis of TAK warrants
further study.
Keywords
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References
- Open knee joint injuries: an evidence-based approach to management.Bull Hosp Joint Dis. 2014; 72: 61-69
- Musculoskeletal trauma surgery.in: Skinner H.B. McMahon P.J. Current Diagnosis & Treatment in Orthopedics. 5th ed. McGraw-Hill, New York2014: 18-87 (Available at:)http://accessmedicine.mhmedical.com.proxy.its.virginia.edu/content.aspx?bookid=675§ionid=45451708Date accessed: July 17, 2017
- Does the saline load test still have a role in the orthopaedic world? A systematic review of the literature.Acta Orthop Traumatol Turc. 2016; 50: 597-600
- Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention.J Orthop Trauma. 2013; 27: 498-504
- Air and its sonographic appearance: understanding the artifacts.J Emerg Med. 2017; 53: 241-247
- Ultrasound of the knee.Eur J Ultrasound. 2001; 14: 57-71
- Acute knee trauma: role of ultrasound.Clin Imaging. 2007; 31: 147
Article info
Publication history
Published online: July 30, 2019
Accepted:
June 8,
2019
Received in revised form:
May 3,
2019
Received:
March 7,
2019
Footnotes
Streaming video: Two brief real-time video clips that accompany this article are available in streaming video at www.journals.elsevierhealth.com/periodicals/jem. Click on Video Clip 1 and Video Clip 2.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
