The incidence of knee osteoarthritis is increasing with the aging population. Therefore, we're interested in exploring safe and minimally invasive treatments for patients with KOA. The main treatments for KOA include conservative therapies, like patient education, lifestyle adjustments, physical therapy, or therapeutic aids and orthotics, and the medication and the intra knee surgery.
Patients with KOA often undergo surgery after the failure of conservative treatment. Acupotomy can be performed in conjunction with conservative treatment. Acupotomy is a less invasive surgery than arthroscopy.
Ultrasound-guided acupotomy can be used to visualize muscle and facial lesions in real time, allowing complete identification of relative anatomy and the thereby improving the accuracy and safety of acupotomy. To begin, prepare the treatment room equipped with an air filtration system. After explaining the needle-knife therapy procedure, instruct the patient to lie down in a supine position with the affected knee joint fully exposed.
Place a thin pillow under the affected knee joint, and ask the patient to abduct the contralateral knee slightly. Mark the pain points in the affected knee joint upon applying finger pressure. Then using the ultrasound probe, scan along the short and long axes of the quadriceps tendon, knee tibial contralateral ligament, fibular collateral knee ligament, patella tendon, and the tenderness point.
Then, using cotton ball soaked in type II skin disinfectant, wipe the area around the marked point on the knee and position a sterile towel so that the mark is at its center. Extract five milliliters of 2%lidocaine and five milliliters of sterile water onto a 10 milliliter syringe, and replace the 22 gauge needle with a 25 gauge one. After fitting the sterile protective cover over the ultrasound probe, apply the sterile ultrasonic gel to the probe.
Holding the probe in the left hand, place it on the marked point and confirm the target in the ultrasound image. With the right hand, insert the syringe needle into the skin alongside the probe so that the syringe needle and the target are in the same field of view. After ensuring no blood returns upon aspiration, inject each target with one to two milliliters of 1%lidocaine working solution.
Next, with the right hand, insert the needle knife into the lidocaine site, aligning it parallel to muscle and ligament fibers to prevent cutting them. Perform a longitudinal incision followed by stripping, and release the adhesion. Remove the knife needle upon feeling a sense of looseness under the knife.
For postoperative care, press the injection site with a dry, sterile cotton ball for one minute, and with a sterile self-adhesive dressing, cover the surgical area. Let the patient sit quietly at the door of the operating room for around 15 minutes to avoid postoperative discomfort. To evaluate the patient after three acupotomy treatments, instruct the patient to lie in a supine position and place a thin pillow under the popliteal fossa of the affected knee joint to fully expose it.
Press the power button to turn on the ultrasound machine. After pressing the patient button, click on new patient and enter the patient's name. Using the head end of the probe, find the superior edge of the patella and place the tail end on the quadriceps tendon.
Press the freeze button to save the ultrasound image, followed by caliper to test the synovial thickness of the suprapatellar bursa. Finally, record the measurement results and assess the treatment outcome using several parameters. After one week of ultrasound-guided autonomy, the synovial thickness of the suprapatella bursa, VAS and WOMAC scores of the treatment group were significantly lower than that of the control group.
Whereas HSS and the treatment group was significantly higher than that in the control group. In a representative patient, the ultrasound analysis indicated that the synovial thickness of the suprapatella bursa reduced to three millimeters after one week of the acupotomy.
