Clinical utility of ultrasound guidance for intra-articular knee injections: a review

Abstract

Intra-articular corticosteroid and hyaluronic acid injections provide short-term symptom amelioration for arthritic conditions involving structural damage or degenerative changes in the knee. Conventional palpation-guided anatomical injections frequently result in inaccurate needle placement into extra-articular tissue and adjacent structures. The purpose of this review was to determine the effect of ultrasound guidance on the accuracy of needle placement, clinical outcomes, and cost-effectiveness in comparison with anatomical landmark-guided intra-articular large joint injections, with particular emphasis on the knee. A total of 13 relevant studies were identified; five studied the knee, seven studied the shoulder, one used both the knee and shoulder, and none studied the hip. Ultrasound was used in seven studies; the remaining studies utilized air arthrography, fluoroscopy, magnetic resonance arthrography, or magnetic resonance imaging. Across all studies (using all imaging modalities and all joints), needle placement accuracy ranged from 63% to 100% with ultrasound and from 39% to 100% with conventional anatomical guidance. Imaging guidance improved the accuracy of intra-articular injections of the knee (96.7% versus 81.0%, P < 0.001) and shoulder (97.3% versus 65.4%, P < 0.001). In particular, ultrasound guidance of knee injections resulted in better accuracy than anatomical guidance (95.8% versus 77.8%, P < 0.001), yielding an odds ratio of 6.4 (95% confidence interval 2.9–14). Ultrasound guidance notably improves injection accuracy in the target intra-articular joint space of large joints including the knee. The enhanced injection accuracy achieved with ultrasound needle guidance directly improves patient-reported clinical outcomes and cost-effectiveness.

Efficacy and safety of adult human bone marrow-derived, cultured, pooled, allogeneic mesenchymal stromal cells (Stempeucel®): preclinical and clinical trial in osteoarthritis of the knee joint

“…Ultrasound guidance of knee injections could be a better option to more precisely deliver the cells intra-articularly. Berkoff et al have reported that ultrasound guidance of knee injections resulted in better IA accuracy of needle placement than anatomical guidance (95.8% versus 77.8%; P  < 0.001) [58]. This enhanced injection accuracy achieved with ultrasound needle guidance directly improves patient-related clinical outcomes.…”

Long-term clinical benefit and cost-effectiveness of an 8-week multimodal knee osteoarthritis management program incorporating intra-articular sodium hyaluronate (Hyalgan<font face="arial, sans-serif" color="#222222">^&reg;</font>) injections

“…Patients in the current series received five intra-articular knee injections of sodium hyaluronate, with each injection given 1 week apart. Injections were administered under fluoroscopic guidance, which allows for confirmation of tricompartmental HA distribution and improves injection accuracy, resulting in improved patient outcomes vs. anatomical injection guidance 21–23. Patients participated in structured physical therapy and education programs provided by physical therapists 2–3 times per week during the 8-week period.…”

Anatomical and ultrasound navigation of intra joint injections

“…Berkoff и соавт. [7] провели метаанализ исследований, выполненных до декабря 2011 г., с целью сравнения точности и эффективности внутрисуставных инъекций под УЗконтролем и «вслепую». Надо отметить немногочисленность данных литературы по обсуждаемой проблематике: подобный сравнительный анализ был выполнен лишь в 7 исследованиях [8][9][10][11][12][13][14], при этом максимальное количество наблюдений касалось в основном лечения коленных и плечевых суставов.…”

“…Результаты анализа показали, что точность размещения иглы при УЗ-контроле варьировала от 63 до 100%, при инъекции «вслепую» -от 39 до 100%. Точность внутрисуставных инъекций в коленный сустав при УЗ-контроле составила 96,7% против 81,0% без применения УЗ-контроля (p < 0,001); для плечевых суставов эти показатели составили соответственно 97,3 и 65,4% (p < 0,001) [7]. J.S.…”