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The preferred technique for knee synovium biopsy and synovial fluid arthrocentesis

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Abstract

For knee osteoarthritis and related conditions, analysis of biomarkers hold promise to improve early diagnosis and/or offer patient-specific treatment. To compare biomarker analyses, reliable, high-quality biopsies are needed. The aim of this work is to summarize the literature on the current best practices of biopsy of the synovium and synovial fluid arthrocentesis. Therefore, PubMed, Embase and Web of Science were systematically searched for articles that applied, demonstrated, or evaluated synovial biopsies or arthrocentesis. Expert recommendations and applications were summarized, and evidence for superiority of techniques was evaluated. Thirty-one studies were identified for inclusion. For arthrocentesis, the superolateral approach in a supine position, with a 0°-30° knee flexion was generally recommended. 18-gage needles, mechanical compression and ultrasound-guidance were found to give superior results. For blind and image-guided synovial biopsy techniques, superolateral and infrapatellar approaches were recommended. Single-handed tools were preconized, including Parker-Pearson needles and forceps. Sample quantity ranged approximately from 2 to 20. Suggestions were compiled for arthrocentesis regarding approach portal and patient position. Further evidence regarding needle size, ultrasound-guidance and mechanical compression were found. More comparative studies are needed before evidence-based protocols can be developed.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We gratefully acknowledge medical librarian Faridi S. van Etten-Jamaludin of the Amsterdam UMC for consultation. We gratefully acknowledge Jozef J.M. Suskens and Beate Emanuel for their assistance with the artwork.

Funding

This study was funded by the Dutch Research Council (NWO) domain Applied and Engineering Sciences. Stichting voor de Technische Wetenschappen, William Hunter Revisited (P15-23), Pieter J Emans.

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Authors and Affiliations

  1. Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands

    Marie Fuentes--Braesch & Gabriëlle J. M. Tuijthof

  2. Department of Orthopedic Surgery, Maastricht UMC+, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands

    Marie Fuentes--Braesch, Pieter J. Emans & Kaj S. Emanuel

  3. Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

    Kaj S. Emanuel

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  1. Marie Fuentes--Braesch
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Contributions

Conception and design: KSE, GJMT, PJE. Data collection: MF-B and KSE. Writing: original draft: MF-B and KSE. Writing: Review and editing: GJMT, PJE. Final approval: MF-B, GJMT, PJE, KSE. To have made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and have drafted the work or revising it critically for important intellectual content; and gave final approval of the version to be published; and are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Kaj S. Emanuel.

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Fuentes--Braesch, M., Tuijthof, G.J.M., Emans, P.J. et al. The preferred technique for knee synovium biopsy and synovial fluid arthrocentesis. Rheumatol Int 43, 1767–1779 (2023). https://doi.org/10.1007/s00296-022-05256-4

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