Placement of intra-articular injection verified by the backflow technique

Mathieu, Luc; Pham, T.; Chagnaud, Christophe; Lafforgue, P.; Legré, Virginie

doi:10.1016/j.joca.2006.02.013

Cited by 45 publications

(38 citation statements)

References 10 publications

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“…The study found that the injector's experience influenced the accuracy rate of blinded injections at the SLP site; accuracy rate of 55% (95% CI 34–74) for the less experienced injector compared to 100% (95% CI 81–100) for the more experienced injector [36]. Luc et al [32], however, in their trial of 33 knee injections reported a similar accuracy for blinded injections at the SLP site for a clinical fellow (96%) and experienced rheumatologist (100%). Two other publications that included “unknown” sites of blinded knee injections found similar accuracy irrespective of the level of experience, seniority, and training [2,4].…”

Section: Between-study Analysesmentioning

confidence: 98%

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Where and how to inject the knee—A systematic review

Maricar

Parkes

Callaghan

et al. 2013

Seminars in Arthritis and Rheumatism

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ObjectivesThe knee can be injected at different anatomic sites with or without image-guidance. We undertook a systematic review to determine the accuracy of intra-articular knee injection (IAKI) and whether this varied by site, use of image-guidance, and experience of injectors, and whether accuracy of injection, site, or use of image-guidance influenced outcomes following IAKIs.MethodsMedline, Embase, AMED, CINAHL, Web of Knowledge, Cochrane Central Registers for Controlled Trials up to Dec 2012 were searched for studies that evaluated either accuracy of IAKIs or outcomes related to accuracy, knee injection sites, or use of image-guidance. Within-study and between-study analyses were performed.ResultsData from 23 publications were included. Within-study analyses suggested IAKIs at the superomedial patellar, medial midpatellar (MMP), superolateral patellar (SLP) and lateral suprapatellar bursae sites were more accurate when using image-guidance than when blinded (ranges of pooled risk difference 0.09–0.19). Pooling data across studies suggested blinded IAKIs at the SLP site were most accurate (87%) while MMP (64%) and anterolateral joint line (ALJL) sites were (70%) least accurate. Overall about one in five blinded IAKIs were inaccurate. There was some evidence that experience of the injector was linked with improved accuracy for blinded though not image-guided injections. Based on a small number of studies, short but not longer-term outcomes for ultrasound-guided were found to be superior to blinded IAKIs.ConclusionsImage-guided IAKIs are modestly more accurate than blinded IAKIs especially at the MMP and ALJL sites. Blinded injections at SLP site had good accuracy especially if performed by experienced injectors. Further studies are required to address the question whether accurate localization is linked with an improved response.

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Section: Between-study Analysesmentioning

confidence: 98%

“…Cunnington et al [2] reported 91% accuracy when a research fellow performed the injections using sonographic-guidance while Luc et al [32] reported 100% accuracy when a medical fellow used “backflow of injected fluid” during IAKIs to confirm intra-articular placement of needles.…”

Section: Between-study Analysesmentioning

confidence: 99%

Where and how to inject the knee—A systematic review

Maricar

Parkes

Callaghan

et al. 2013

Seminars in Arthritis and Rheumatism

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“…When all approaches are taken together, total accuracy of palpation-guided knee joint injections in the clinical setting has ranged from 40% to 100% (4,9,15,18,36,38,41,56,99). This complicates comparison between studies using different approaches or variations of these approaches.…”

Section: Knee Structuresmentioning

confidence: 99%

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

Hall

2013

Current Sports Medicine Reports

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There is much debate in the sports medicine community regarding the need for image guidance during peripheral joint and soft tissue injections. With the increasing availability of office-based ultrasound, many injections that were performed previously with a palpation-guided technique are being performed now under direct sonographic guidance. However some question the need for such guidance, particularly given the increased cost. This manuscript will review the reported accuracy and efficacy for various injections commonly performed in a sports medicine practice.

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“…A majority of the studies (49/57 (86%))6 7 9 11–13 15 17–25 27–30 32–51 53–61 evaluated injections in a single joint, whereas 14% (8/57)5 8 10 16 26 31 52 55 assessed injections in more than one joint. Thirty-five per cent (20/57) of the studies evaluated knee injections,8–10 13 15 16 19–23 26 31 32 36 37 48 52 56 57 46% (26/57) evaluated glenohumeral (GH) joint injections,5 7 8 10 11 15–17 24–26 28 29 31 38–40 42 43 46 47 49 52 54 60 61 21% (12/57) evaluated hip injections8 12 27 30 33 35 41 44 45 50 52 59 62 and 4% (2/57) evaluated sacroiliac (SI) joint injections 18 34. Four studies (7%) assessed injections in the ‘shoulder’, but did not specify which shoulder structure or joint they were injecting 6 53 55 58…”

Section: Resultsmentioning

confidence: 99%

“…The level of evidence for a majority of the studies evaluating major joint USGI accuracy (15/23 (65%))5 8 9 15 16 18 20 21 23 27 30 32 34 36–39 41 42 44–46 49 or LMGI accuracy (28/28 (100%))5 7 9–13 17 19 21–26 28 31 32 36–38 40 43 47 48 50 60 61 were level 1 or 2. The mean accuracy of GH, hip and knee joint USGIs in studies with level 1 or 2 evidence ranged from 91% to 100%,5 8 9 15 18 21 23 32 36–39 42 46 49 whereas the mean accuracy of LMGIs were between 64% and 81% 5 7 9–13 17 19 21–26 28 31 32 36–38 40 43 47 48 50 60 61. These findings provide strong evidence that USGIs in the GH, hip and knee joints are more accurate than LMGIs.…”

Section: Resultsmentioning

confidence: 99%

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

Finnoff

Hall

Adams³

et al. 2014

Br J Sports Med

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Background The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilisation is by nonradiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases and hydrodissections. Objective Critically review the literature related to the accuracy, efficacy and cost-effectiveness of ultrasoundguided injections (USGIs) in major, intermediate and small joints; and soft tissues. Design Systematic review of the literature. Results USGIs are more accurate than landmark-guided injections (LMGIs; strength of recommendation taxonomy (SORT) Evidence Rating=A). USGIs are more efficacious than LMGIs (SORT Evidence Rating=B). USGIs are more cost-effective than LMGIs (SORT Evidence Rating=B). Ultrasound guidance is required to perform many new procedures (SORT Evidence Rating=C). Conclusions The findings of this position statement indicate there is strong evidence that USGIs are more accurate than LMGI, moderate evidence that they are more efficacious and preliminary evidence that they are more cost-effective. Furthermore, ultrasound-guided (USG) is required to perform many new, advanced procedures and will likely enable the development of innovative USG surgical techniques in the future. BACKGROUND

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Placement of intra-articular injection verified by the backflow technique

Cited by 45 publications

References 10 publications

Where and how to inject the knee—A systematic review

Where and how to inject the knee—A systematic review

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

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

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