Purpose Arthroscopy is one of the most common interventions in
orthopedics. Hence it is important to train users early in order to ensure the
safest possible identification of access portals (AP). This prospective study
aimed to compare a palpatory (PalpMethod) with a sonographic (SonoMethod) method
for AP location in the shoulder and knee joints.
Materials and
Methods The study included trainee doctors (n=68) attending workshops
(lasting approx. 90 minutes). In these workshops a teaching video initially
demonstrated the PalpMethod and SonoMethod of AP identification. An experienced
operator first marked the access portals on the test subject with a UV pen
(determined ideal point [DIP]). Adhesive film was then affixed to the puncture
regions. Subsequently participants marked on shoulders and knees first the point
determined by palpation, then the point determined by sonography. Analysis
involved DIP visualization with a UV lamp and employed a coordinate system
around the central DIP. In addition, participants completed an evaluation before
and after the workshop.
Results The analysis included 324 measurements
(n=163 shoulders and n= 161 knees). The majority of participants had not
previously attended any courses on manual examination (87.9%) or musculoskeletal
ultrasound (93.9%). Overall, the markings participants made on the shoulder
using the SonoMethod were significantly closer to the DIP than those made by the
PalpMethod (Palp 18.8mm ± 14.5mm vs. Sono 11.2mm ± 7.2mm; p<0.001). On the
knee, however, the markings made by the PalpMethod were significantly closer to
the DIP overall (Palp 8.0mm ± 3.2mm vs. Sono 12.8mm ± 5.2mm; p<0.001).
Conclusion The results show that the SonoMethod produces more accurate markings
on the shoulder, while the PalpMethod is superior for the knee.