In Singapore, knee pain or swelling are some of the most common reasons for seeing a doctor. In fact, many patients are particularly concerned about knee effusions even when not associated with pain.
There can be many varied reasons for a patient developing a knee effusion. These include:
The type of fluid aspirated often provides a clue to the diagnosis. Occasionally laboratory tests are required to confirm the diagnosis. Table 1 offers a simple but not exhaustive guide to some of the more common causes for effusions from knee aspirations in Singapore.
|Type of Aspirate||Differential Diagnosis|
|Straw coloured effusion||Acute or chronic meniscal injury
|Frank blood||Acute ligamentous injury or osteochondral fractures|
|Fat globules||Osteochondral fractures|
|Presence of birefringent crystals under polarized light||Gout or Pseudogout|
|Turbid fluid or pus||Infection|
Aspiration of a tense haemarthrosis or very large effusion will quite often bring immediate pain relief to a patient. Supplementary treatment with analgesia and ice is also useful.
The most important landmark for aspirating the knee is the lateral edge of the patella.
1. Start off by identifying the superior pole and lateral edge of the patella (Figure 1).
2. Identify the soft spot approximately 1 cm below the lateral edge of the patella. This is the landmark for aspirating the knee (Figure 2).
3. Lightly hold the patella between the thumb and index finger. The needle should be introduced into the soft spot just under the patella. (Figure 3)
4. There should be no resistance to flow and the patient should be comfortable throughout the procedure. Occasionally the needle may need to be withdrawn or angled slightly to maximize extraction of the effusion or blood.
Frank blood is aspirated from this patients knee suggesting the likelihood of an Anterior Cruciate Ligament tear. (Figure 4).
If there is a clinical suspicion of infection, urgent Gram stain should be requested for and the aspirate should be sent for microscopy and culture.