La radiologia medica

, Volume 123, Issue 5, pp 359–366 | Cite as

Learning curves of two different techniques for the intra-articular injection of the knee joint under fluoroscopic guidance

  • Paolo Simoni
  • Olivier Malaise
  • Mounia El Hachemi
  • Angelo Tromba
  • Grammatina Boitsios



The aim of the study was to compare the learning curves of three beginner operators using two different techniques of intra-articular injection of the knee under fluoroscopic guidance with a superolateral approach.

Materials and methods

In total, 177 consecutive patients (72 females (40.7%) and 105 males (59.3%), mean age 42.2 ± 15.0 years) scheduled for a computed tomography (CT) arthrography and without joint effusion on the lateral X-rays were enrolled. They underwent an intra-articular injection of the knee under fluoroscopic guidance with a superolateral approach. Patients were randomly assigned to three different operators, including a junior supervisor and two first-year residents in radiology who never performed an intra-articular injection of the knee before the present study. Procedures in lateral or supine position were randomly assigned to three operators.


There was a higher rate of successful injections with the lateral position (92.1%) than with supine position (80.2%) (odds ratio (OR) 4.52, 95% confidence interval (CI) 1.46–14.0). A significant learning effect was observed for the supine position, while none was observed for the lateral position. Pain and time of fluoroscopy did not differ between the two procedures (p = 0.85 and p = 0.10, respectively). Junior supervisor had a higher rate of successful intra-articular injection compared with the other two operators (p = 0.0072). There was a statistically significant higher rate of extravasation with the supine position (66.3%) than with lateral position (19.7%) (p < 0.0001, OR 0.13, 95% CI 0.06–0.25).


The intra-articular injection of the knee under fluoroscopic guidance with the patient in lateral position is an easy technique for operators in training with a low rate of extravasation. Lateral position does not require a supplementary irradiation and does not increase the procedural pain. Personal operator’s skill is an independent factor in determining the success of the training.


Knee Injections, intra-articular/methods Arthrography Fluoroscopy Reproducibility of results interventional Humans 



Adelin Albert, PhD, and Laurence Seidel, PhD, are kindly acknowledged for the statistical analysis.


Therefore, no fund was granted to the authors to perform this study.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest to declare.

Ethical standards

No animals were involved in the present study. 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 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The local institutional ethics committee approved the study, and an informed consent was obtained from all individual participants included in the study.


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Copyright information

© Italian Society of Medical Radiology 2017

Authors and Affiliations

  • Paolo Simoni
    • 1
    • 3
  • Olivier Malaise
    • 3
  • Mounia El Hachemi
    • 2
  • Angelo Tromba
    • 2
  • Grammatina Boitsios
    • 1
  1. 1.“Reine Fabiola” Children’s University Hospital, Université Libre de Bruxelles (ULB)BrusselsBelgium
  2. 2.Radiology DepartmentCHU de LiègeLiègeBelgium
  3. 3.Rheumatology DepartmentCHU de LiègeLiègeBelgium

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