Poster 405 Accuracy of Ultrasound‐guided and Palpation‐guided Knee Injections by an Experienced and Less‐experienced Injector by Using a Superolateral Approach: A Cadaveric Study

Abstract

Results: Participants rated the system technically acceptable, clinically appropriate, operationally effective, safe, and comfortable. The games ranged in levels of engagement (5-10), difficulty, (3-10), and competitiveness (0-10). Recordings from the sensors confirmed the scores given by the participants. A higher range of motion activity was present during games that were described as challenging and engaging. Discussion: Postburn joint contractures are common, difficult to treat, and negatively impact quality of life and function. Gaming and virtual reality have been explored in burn wound care management, but there is a paucity of data regarding its use in rehabilitation therapy interventions. There is a clinical need for novel treatment approaches to this important problem. Conclusions: Our novel gaming system is feasible for use in the burn population for upper extremity range of motion therapy. Future analysis will evaluate the efficacy of this intervention in treating upper extremity burn contractures. Disclosures: H. M. Curtiss, none. Objective: To evaluate the accuracy of ultrasound-guided and palpation-guided knee injections by an experienced and a less-experienced clinician by using a superolateral approach. Design: A single-blinded, prospective study. Setting: Academic institution procedural skills laboratory. Participants: Twenty cadaveric knee specimens without trauma, surgery, or major deformity. Interventions: Each specimen received an ultrasound (US) guided and palpation-guided knee injection by an experienced and a less-experienced clinician with colored liquid latex by using a superolateral approach. The injection order was randomized. The specimens were subsequently dissected by a blinded investigator and assessed for accuracy. Main Outcome Measures: Accuracy was divided into 3 categories: (1) accurate (all of the injectate within the joint), (2) partially accurate (some of the injectate within the joint and some within the periarticular tissues), and (3) inaccurate (none of the injectate within the joint). The accuracy rates were calculated for each clinician and guidance method. Results: US-guided knee injections by using a superolateral approach were 100% accurate for both clinicians. Palpation-guided knee injections by using a superolateral approach were significantly influenced by experience with the less-experienced investigator demonstrating an accuracy rate of 55% (95% confidence interval, 34%-74%), whereas the more experienced investigator's accuracy rate was 100% (95% confidence interval, 81%-100%). Conclusions: US-guided knee injections by using a superolateral approach are very accurate in a cadaveric model, whereas the accuracy of palpation-guided knee injections by using the same approach is variable and appears to be significantly influenced by clinician experience. These findings suggest that US guidance should be considered when performing knee injections with a superolateral approach that requires a high degree of accuracy.