The knee joint can be entered either medial or lateral to the patella. With the patient supine, the knee should be fully extended and the quadriceps muscle relaxed.

The midpoint of the patella is identified. The insertion point of the needle is located approximately 1 cm inferior to the patellar edge, either lateral ( Fig 278-4) or medial (Fig 2.7.8.-5) to the middle of the patella. The needle should be directed posterior to the patella and horizontally toward the joint space. Compression applied over the joint space or "milking" of the bursae, on the patellar side opposite of the needle insertion site, may facilitate aspiration.

FIG. 278-4. Arthrocentesis of the knee, lateral approach.
FIG. 278-5. Arthrocentesis of the knee, medial approach.
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