hi Dr Frank Johnson from Sports Medicine ultrasound I'm here to drain a swollen knee and inject PRP now my patient and I go way back we've been injecting PRP cortisone hyaluronic acid over the past uh what almost 10 years and we found the PRP worked best she's waiting for a knee replacement but her knee is doing so well with the PRP and activity modification she loves to play soccer but just not playing as much as she used to before she's doing so well with the PRP that she doesn't want knee replacement right now so we'll do the drainage now so first things first we got my table nice and high I strongly suggest you get your eye at the level of the needle second thing is I've got an absorptive towel on the bottom because normally what happens when I drain the knee either a bit of blood will trickle down or a bit of the serous fluid that I drained from the knee will trickle down and you certainly don't want that on your table I don't actually need sterile ultrasound gel because I find the skin disinfectant does a great job of conducting the ultrasound signal as long as you don't get too much bubbling freeze I'm going to place the ultrasound probe onto the proximal patella I then gently Rock the probe onto the quadricep increase depth increase gain so what we see in the top right of the screen is the patella the quadriceps tendon the super patellar fat pad we see at the bottom of the screen the femur and the pre-femeral fat pad if I slide my probe to the lateral third of the patella that's usually where the greatest amount of effusion is I'll then rotate the probe 90 degrees and we see the effusion there I then take a little bit of anesthetic put a small wheel in the skin and pass the needle through the vastus lateralis and eliotibial tract into the effusion I freeze up the needle track on the way out and the lidocaine works almost instantly I'm then ready to take an 18 gauge 1.5 inch needle pass it through the needle track and here's where using ultrasound guidance is Paramount if I were to be doing this without ultrasound guidance if my needle tip were to travel superficially I'd land in the quadriceps tendon and wonder why I wasn't getting any effusion if my needle tip were to travel deep it would land in the pre-femeral fat pad and I would wonder why I wasn't getting any more fluid there we can see the needle tip between the two so that is essentially how I do an ultrasound guided aspiration of a neofusion and we're ready to inject the PRP now
