Single-puncture arthrocentesis - a technical review

A large array of single-puncture arthrocentesis (SPA) techniques have been described in the literature, leading to considerable heterogeneity and limiting the comparability between procedures. The aim of this article is to review and classify the various SPA techniques published.

A literature review was conducted using the MEDLINE database with the search term "single puncture arthrocentesis". All studies that included references to SPA were considered eligible. Full-text articles were then assessed, and those that did not describe the SPA method were excluded.

Thirty-three articles were included, representing a total of 864 patients and 611 SPA procedures. The techniques were classified into four categories: (1) single device-simple flow, using a single needle for inflow and outflow (i.e. SPA type 1); (2) single device-double flow, involving a cannula with two separate lumina; (3) welded devices, welded needles or cannulas or catheters into a single device with two separate lumina; and (4) concentric devices, consisting of two devices of different diameters and lengths, one inserted within the other. Twenty-three studies reported a reduction in pain associated with an improvement in maximum mouth opening. Single device-simple flow techniques appeared to be associated with longer operative times and lower irrigation volumes. Welded and concentric devices appeared to be the easiest to use.

No difference has been shown yet between different SPA techniques. This technical review and classification could help design comparative studies leading to better assessment of SPA techniques.