Does the anteromedial or anterolateral approach alter the rate of joint puncture in injection of the ankle?

Abstract

Injection or aspiration of the ankle may be performed through either an anteromedial or an anterolateral approach for diagnostic or therapeutic reasons. We evaluated the success of an intra-articular puncture in relation to its site in 76 ankles from 38 cadavers. Two orthopaedic surgical trainees each injected methylene blue dye into 18 of 38 ankles through an anterolateral approach and into 20 of 38 through an anteromedial. An arthrotomy was then performed to confirm the placement of the dye within the joint. Of the anteromedial injections 31 of 40 (77.5%, 95% confidence interval (CI) 64.6 to 90.4) were successful as were 31 of 36 (86.1%, 95% CI 74.8 to 97.4) anterolateral injections. In total 62 of 76 (81.6%, 95% CI 72.9 to 90.3) of the injections were intra-articular with a trend towards greater accuracy with the anterolateral approach, but this difference was not statistically significant (p = 0.25). In the case of trainee A, 16 of 20 anteromedial injections and 14 of 18 anterolateral punctures were intra-articular. Trainee B made successful intra-articular punctures in 15 of 20 anteromedial and 17 of 18 anterolateral approaches. There was no significant difference between them (p = 0.5 and p = 0.16 for the anteromedial and anterolateral approaches, respectively). These results were similar to those of other reported studies. Unintended peri-articular injection can cause complications and an unsuccessful aspiration can delay diagnosis. Placement of the needle may be aided by the use of ultrasonographic scanning or fluoroscopy which may be required in certain instances.

The Accuracy and Efficacy of Palpation versus Image-Guided Peripheral Injections in Sports Medicine

“…Palpation-guided tibiotalar joint injections have reported accuracy rates of 67% to 77% in the clinical setting and 78% to 100% in the cadaveric specimens (34,41,43,55,105). Palpation-guided tibiotalar joint injections have reported accuracy rates of 67% to 77% in the clinical setting and 78% to 100% in the cadaveric specimens (34,41,43,55,105).…”

American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine

“…TT joint USGIs were found to be 100% accurate in three level 2 studies 66 71 80. The mean TT joint LMGI accuracy was 64% in two level 1 studies26 31 and 87% in three level 2 studies 65 66 80. The mean ST joint USGI accuracy of three level 2 studies was 97%,66 71 75 while three level 2 studies reported the accuracy of LMGI to be 89% 66–68.…”

“…Seventy-four per cent (17/23) of the studies evaluated injections into a single joint8 63–65 67–70 72–80 and 26% (6/23) assessed injections into multiple joints 16 26 31 52 66 71. Injections into the following joints were evaluated: sternoclavicular (SC; 1/23 (4%)),79 acromioclavicular (AC; 7/23 (30%)),26 63 69 70 72 73 78 elbow (3/23 (13%)),16 26 31 wrist (4/23 (17%)),8 16 26 31 distal radioulnar (DRU; 1/23 (4%)),77 scaphotrapeziotrapezoidal (STT; 1/23 (4%)),74 proximal tibiofibular (TF; 1/23 (4%)),76 tibiotalar (TT; 7/23 (30%)),16 26 31 65 66 71 80 subtalar (ST; 5/23 (22%)),66–68 71 75 and midfoot (1/23 (4%)) 64…”

A physiotherapy perspective of musculoskeletal imaging in sport

“…This is now a relevant issue for physiotherapists as many working in an extended scope role in the NHS are now performing injections. It has been documented that 14-71% of injections carried out ''blind''-without image guidance-miss their target [23][24][25][26][27]. What we do not know is whether this makes a difference in clinical efficacy.…”