hi Dr Frank Johnson from Sports Medicine ultrasound I'm here to finish off a knee effusion aspiration and PRP injection now I've actually made my job really really difficult and without ultrasound this would be highly challenging with ultrasound I'll walk you through it what we see here on the right hand of the screen is the patella the quadriceps tendon the super patellar fat pad on the bottom left of the screen we see the femur and the pre-femoral fat pad the effusion we saw in part one of this video isn't present anymore so how do I know where to inject the PRP into the actual knee joint fluid well in the old days you would simply go through the front and hope it got there some people Advocate simply just sticking it in but the trouble is if we land inside the pre-femeral fat pad the patient's going to have a big flare-up and it may not help the patient that much some people Advocate placing it under the patella medially and that's kind of my last approach if I can't get this one but I'm pretty confident about this one what we do here is we simply rotate the probe 90 degrees again I've got a little bit of sterile gel here just to make my job a touch easier once again top of the screen quadriceps tendon bottom of the screen femur in between is a super patellar fat pad and pre-femoral fat pad if I make a slight movement of my probe distally towards the knee we do see all of a sudden a black area on the screen pop out that's the fluid that's my target here we are we're going to come from the left hand side of the screen into that black fluid pocket I brace everything I've got my sterile gloves on I've got my sterile drape here at the proximal end here we go you can see the needle coming from the left if I were to inject it right here it would be inside the pre-femoral fat I don't want that if I pass the needle just that tiny bit further this is actually inside the fluid of the knee joint make a slight hand adjustment brace up against the patient's skin and inject and you can see that flowing all the way across the screen it would be incorrect if my needle were back here and that's the beauty of the ultrasound is I can see exactly where the needle tip is and I can see exactly where the flu is flowing
