hi Dr Frank Johnson from Sports Medicine ultrasound we're here to do an injection of PRP into a knee joint now my patient has some arthritis in her knees and she's not super keen on a replacement for lots of different reasons she had an amazing response to PRP in the past and we're looking to recreate that today one of the nice things about ultrasound is I can actually see the Contours of the bone in you know an infinite number of angles we were able to identify that on this medial aspect of the patellofemoral joint there actually appears to be some impingement to some of the bone spurs so what do we see we see on the right hand side of the screen the patella on the left hand side of the screen the femur and you can see there's an area where the two bones are coming really close together and actually if we scan a little distal there might actually be even a little osteochondral loose body and if you rely entirely on x-rays or radiographs you know sometimes these osteochondral loose bodies move around sometimes they'll be in the Baker cyst sometimes the next time you see the patient a year or two later it'll be in the medial gutter here sometimes in the lateral gutter sometimes actually get jammed up underneath patellofemoral joint play small event aesthetic increase gain increase gain increase depth so this is a sneaky little way if for whatever reason you can't inject the superlateral recess and if patients do have an effusion in the medial gutter here is a perfect place to get PRP or any injection into the joint fluid so small amount of anesthetic so let the anesthetic kick in for a second and again there's some disagreement about anesthetic and PRP my Approach is if my patient wants me to use a bit of anesthetic absolutely why wouldn't I do it there's nothing that I've ever seen that says anesthetics inactivate stem cells or PRP apart from in a petri dish I'll just pull this right leg over thank you very much that's great excellent we can make out the needle coming in from the top left of the screen and as we inject that you see it fills up that synovial fluid in that medial gutter and that's it so once again if you're really struggling to do an intra-articular knee injection from the front or the super patellar recess the patient has fluid in the medial gutter nice easy way to do a knee injection
