Patient has a history of knee arthritis. She's had PRP in the past, but she reported that the previous PRP injection was with a very small volume of blood. So I'm going to guess this was one of those kits that was done either with a very small tube that gets spun out, or maybe even a test tube of blood, and that's usually inferior to the double spin larger kit, which requires 30 to 60ml of blood and a six, and a double spin technique, which will yield anywhere between 7 and 10 times the amount of platelets.
And platelet count is quite important. Here. We're imaging her super patella region above the knee with the T mode feature of the Clarus scanner, which is showing me the tendon, as well as the fat pads subcutaneous tissue. And here's the patella. This bone over here you have the super patellar tendon over here.
And the super patella Bursa is above the knee. You have the super patella fat pad right over here above the patella, which is often triangular in shape. And then you have the oval, oval pre femoral fat pad which is to the left of the screen. And the joint space is between that region. It's basically a super patellar recess that leads into the joint space where we could give the injection on a transverse view.
We can find the super patellar tendon in the center and the trochlear. The recess between the femoral condyles and the line between the fat pads is typically the target. We use decreased depth.
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Unfreeze,
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unfreeze.
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Alternatively, we can inject below the knee. Can you bend your knee, please? Thank you.
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And here we have the patellar tendon. It hurts you
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with this part hurts right here. Where is the worst pain? The center or center? On the side and lateral. Right here. The other side. The medial right here.
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Okay, so just scanning here, we see the go up more. Toe up more okay. First let me just get my anatomy. So this is the patella to the to the left of the screen. And then underneath it is underneath it is the patellar tendon.
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And the fat pad is behind the patellar tendon above the tibia which is right here.
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Now I'm just going to examine her medial knee. Can you please take this out. Flatten your knee. Thank you. I'm just gonna leave this over here.
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So I'm going to palpate and hurt you over there.
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Okay, so she has me only tenderness. So I'm going to examine it here is.
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Yeah. Like right in there. Okay. So let me just get my location first.
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I first need to find what I'm looking for.
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Aha. Right here hurt you. Okay. So what we see on the screen here is the meniscus at the center of the medial. You also see some bone spurs. She does not have a large joint space here. And the meniscus looks a little thinner than normal. So she does have signs of osteoarthritis. There may be a meniscus tear. It's hard for me to tell here, but I do see a spot where you most likely are having degeneration and pain.
You mentioned the medial aspect of your knee hurts you and that kind of that correlates with what I'm seeing here. So when I put the PRP in, I could I could target it more towards the medial aspect and try to get some over here. You have the
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medial collateral ligament connected to the meniscus which is right above the tissue here. You have deeper and more and more superficial fibers that are connected. And when there's an injury to the MCL, the meniscus may be affected.
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Okay. So I have a nice amount of PRP. I'm actually going to put some in multiple places. I'm going to come out of plain to put some right by this meniscus right here. And the medial collateral ligament which I'm going to center right here. Her her foot is inverted. So therefore this is more medial than it looks.
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It's going to be a couple of injections okay. Okay. 2D 2d
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2d
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Okay, a little pinch.
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How you doing? Right.
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Is this a spot