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Ultrasound-guided injection for the diagnosis and treatment of posteromedial knee friction syndrome

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Abstract

Objective

To describe an ultrasound guided injection technique for diagnosing and treating posteromedial knee friction syndrome, which occurs between the sartorius/gracilis tendons and medial femoral condyle (MFC).

Materials and methods

Our study was IRB-approved and HIPAA-compliant. We identified patients via a retrospective review of medical records and MRI with posteromedial knee pain and isolated edema between MFC and sartorius/gracilis tendons and no evidence for meniscal tear, ruptured Baker’s cyst or degenerative joint disease. Patients were referred for an ultrasound-guided procedure to inject anesthetic and corticosteroid at the site of edema. Procedures were evaluated for technical success, which was defined as satisfactory identification of the injection site and adequate delivery of medication. Follow-up was available up to 8 weeks after the procedure to determine the response and any potential complications.

Results

Fourteen subjects with MRI and symptoms of posteromedial knee friction syndrome underwent 14 injections. Technical success was achieved in all procedures, with no complications. At 8 weeks’ follow-up, 92% of patients had symptom improvement. VAS before and 8 weeks after the procedure changed from 5.2 ± 2.7 to 0.9 ± 2.1 (p = 0.0002), respectively.

Conclusion

Ultrasound-guided injection of edema between the MFC and sartorius/gracilis tendons supports the diagnosis of a posteromedial knee friction syndrome and successfully treats its associated symptoms.

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Authors and Affiliations

  1. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street – YAW 6, Boston, MA, 02114, USA

    F. Joseph Simeone, Arvin Kheterpal, Connie Y. Chang, William E. Palmer, Miriam A. Bredella, Ambrose J. Huang & Martin Torriani

Authors
  1. F. Joseph Simeone
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  2. Arvin Kheterpal
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  3. Connie Y. Chang
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  4. William E. Palmer
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  5. Miriam A. Bredella
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  6. Ambrose J. Huang
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  7. Martin Torriani
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Corresponding author

Correspondence to Martin Torriani.

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Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived for individual participants included in the study. The study was approved by the local Institutional Review Board (IRB) and HIPAA-compliant.

Electronic supplementary material

Video 1

A 52-year-old woman with left medial knee pain. Ultrasound video clip showing dynamic examination with an absence of abnormal or abrupt motion between the sartorius and the gracilis relative to the medial femoral condyle, followed by an injection targeting the area of soft-tissue edema seen on MRI (Fig. 3A) (MOV 15939 kb)

Video 2

A 29-year-old man with right medial knee pain. Ultrasound video clip showing dynamic examination with abrupt motion of the gracilis over the medial femoral condyle, followed by an injection targeting area of soft-tissue edema seen on MRI (not shown) (MOV 9867 kb)

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Simeone, F.J., Kheterpal, A., Chang, C.Y. et al. Ultrasound-guided injection for the diagnosis and treatment of posteromedial knee friction syndrome. Skeletal Radiol 48, 563–568 (2019). https://doi.org/10.1007/s00256-018-3060-z

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  • DOI: https://doi.org/10.1007/s00256-018-3060-z

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