Efficacy of knee joint aspiration in patients with acute ACL injury in the emergency department

Joon Ho Wang; Jin Hyuck Lee; Youngsuk Cho; Jung Min Shin; Byung Hoon Lee

doi:10.1016/j.injury.2016.05.025

Efficacy of knee joint aspiration in patients with acute ACL injury in the emergency department

Injury. 2016 Aug;47(8):1744-9. doi: 10.1016/j.injury.2016.05.025. Epub 2016 May 18.

Authors

Joon Ho Wang¹, Jin Hyuck Lee², Youngsuk Cho³, Jung Min Shin⁴, Byung Hoon Lee⁵

Affiliations

¹ Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea. Electronic address: [email protected].
² Department of Emergency Medicine, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea. Electronic address: [email protected].
³ Department of Emergency Medicine, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea. Electronic address: [email protected].
⁴ Hanyang University School of Medicine, Seoul, South Korea. Electronic address: [email protected].
⁵ Department of Orthopaedic Surgery Kang-Dong Sacred Heart Hospital, Hallym University Medical School, Gil-dong, Seoul 134-701, South Korea. Electronic address: [email protected].

PMID: 27262773
DOI: 10.1016/j.injury.2016.05.025

Abstract

Purpose: To evaluate the influence of joint aspiration on the sensitivity of physical examination for diagnosing acute anterior cruciate ligament (ACL) lesion in the second outpatient-department (OPD) follow-up referred from emergency department (ED).

Methods: This retrospective study included sixty patients underwent ACL reconstruction with initial visit at ED. They were divided into two groups based on the presence or absence of joint aspiration at ED. All participants were referred to second OPD follow-up within 7-14days after the injury. Clinical manifestation (including visual analogue scale (VAS) for pain, range of motion (ROM), and severity of knee effusion) and physical examination (Lachman test and pivot shift test) were checked in ED and the second OPD follow-up.

Results: The group of patients with joint aspiration (G1) showed substantial decreases in mean values of VAS for pain (p=0.005), ROM (p=0.001), and effusion level (p<0.001), even higher VAS and effusion level and lower ROM at the initial visit of ED than the other group (G2). The sensitivity of positive Lachman and pivot shift test was significantly (p<0.05) increased following knee joint aspiration. Positive Lachman test was recorded at 76.5% in the second follow-up in G1, which was significantly (p=0.047) higher than that (47.6%) in G2. The percentage of positive pivot shift test was recorded at 76.5% in the second follow-up in G1, which as significantly (p<0.001) higher than that (31.0%) in G2.

Conclusions: Knee joint aspiration in acute ACL injury with suspected hemarthrosis could be considered as a diagnostic procedure. Joint aspiration in early medical attendance might be able to lower pain scores or raise the sensitivity of physical examination for diagnosing acute ACL injury at follow up visit in orthopedic outpatient department.

Level of evidence: Retrospective cohort study III.

Keywords: Anterior cruciate ligament; Emergency department; Hemarthrosis; Physical examination. joint aspiration.

MeSH terms

Adult
Anterior Cruciate Ligament Injuries / physiopathology
Anterior Cruciate Ligament Injuries / rehabilitation
Anterior Cruciate Ligament Injuries / surgery*
Anterior Cruciate Ligament Reconstruction / methods*
Emergency Service, Hospital*
Female
Follow-Up Studies
Hemarthrosis / etiology
Hemarthrosis / physiopathology
Hemarthrosis / therapy*
Humans
Joint Instability / physiopathology
Knee Joint / physiopathology*
Male
Pain Measurement
Physical Examination
Postoperative Complications
Range of Motion, Articular
Referral and Consultation
Retrospective Studies
Suction / methods*
Treatment Outcome