Sonographically Guided Anterior Cruciate Ligament Injection: Technique and Validation

Smith, Jay; Hackel, Joshua G.; Khan, Umar Zeb; Pawlina, Wojciech; Sellon, Jacob L.

doi:10.1016/j.pmrj.2015.01.014

Cited by 12 publications

(6 citation statements)

References 43 publications

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“…Ultrasonographic examination was performed by a fellowship-trained musculoskeletal ultrasound specialist following a previously validated protocol for the ultrasonographic visualization of the ACL [21][22][23][24][25][26]. Although a linear array ultrasound transducer has been used in previous literature, a 10-3 MHz convex ultrasound transducer (Aplio i800, Canon medical systems, Otawara, Japan) was chosen in this study for better visualization of the ACL from the relatively narrow space between inferior pole of the patella and proximal tibia through the patella tendon.…”

Section: Visualization Of the Acl Using Ultrasoundmentioning

confidence: 99%

Superb microvascular imaging (SMI) detects increased vascularity of the torn anterior cruciate ligament

Takeuchi

Rothrauff

Kanto

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeUltrasound with superb microvascular imaging (SMI) is a novel microvascular imaging technology which may be useful to assess the vascularity of the torn anterior cruciate ligament (ACL) as a potential measure of healing potential following surgery. This study aimed to quantify the vascularity of the torn and intact ACL using ultrasound with SMI. Methods23 patients (mean age ± standard deviation, 27.1 ± 12.8 years), who were diagnosed with an ACL tear with an intact contralateral ACL were enrolled (ACL injury group). Ten healthy volunteers (36.1 ± 4.9 years) who had intact ACLs in both knees were also recruited (ACL healthy controls). The vascularity of the ACL was assessed using SMI within 15 mm from the tibial insertion in both knees. The amount of the vascular signal was assessed using a semi‐quantitative grading scale (vascularity grade: grade 0–3) and a quantified ratio of vascularized area with respect to total area of the region of interest (vascularity ratio). ResultsIn the ACL injury group, a significantly higher vascularity grade and ratio were observed in the torn ACL (vascularity grade 0–3: 1, 8, 7, and 7 patients, respectively; vascularity ratio: 1.3 ± 1.4%) than the contralateral intact ACL (vascularity grade 0–3: 21, 1, 1, and 0 patients, respectively; vascularity ratio: 0.1 ± 0.5%) (P < 0.001), whereas no significant difference was observed between both ACLs in the ACL healthy control group. ConclusionsSMI was useful to assess the increased vascularity in torn ACL, which may reflect the potential for, or state of, ACL maturation following reconstruction or repair. Level of evidenceLevel III.

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Section: Visualization Of the Acl Using Ultrasoundmentioning

confidence: 99%

Superb microvascular imaging (SMI) detects increased vascularity of the torn anterior cruciate ligament

Takeuchi

Rothrauff

Kanto

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…After confirming the needle on the surface of G and ST (Fig. 1c), 0.1 ml of colored diluted latex (33% latex, 66% water) [27] was injected, while peritendinous flow was monitored with sonography (Fig. 1d).…”

Section: Injection Protocolmentioning

confidence: 99%

Preoperative sonographic measurement can accurately predict quadrupled hamstring tendon graft diameter for ACL reconstruction

Takenaga

Yoshida

Albers

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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“…The intra-articular injection was performed immediately after PRP preparation with the participant in the sitting position at 90° of knee flexion, through an anterolateral approach, and without exogenous activation. To increase the accuracy of the knee injection, the puncture needle was located laterally to the patellar tendon and toward the intercondylar notch under ultrasound guidance . After injection, passive knee flexion and extension were performed for 10 cycles.…”

Section: Methodsmentioning

confidence: 99%

Intra-Articular Platelet-Rich Plasma Injection After Anterior Cruciate Ligament Reconstruction

Ye,

Chen,

Qiao

et al. 2024

JAMA Netw Open

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ImportancePlatelet-rich plasma (PRP) has been considered a promising treatment for musculoskeletal disorders. The effects of PRP on clinical outcomes of anterior cruciate ligament reconstruction (ACLR) are controversial.ObjectiveTo compare subjective outcomes and graft maturity in patients undergoing ACLR with and without postoperative intra-articular PRP injection.Design, Setting, and ParticipantsThis surgeon- and investigator-masked randomized clinical trial included patients treated at a national medical center in China who were aged 16 to 45 years and scheduled to undergo ACLR. Participants were enrolled between March 21, 2021, and August 18, 2022, and followed up for 12 months, with the last participant completing follow-up on August 28, 2023.InterventionsParticipants were randomized 1:1 to the PRP group (n = 60), which received 3 doses of postoperative intra-articular PRP injection at monthly intervals, or to the control group (n = 60), which did not receive postoperative PRP injection. Both groups had the same follow-up schedule.Main Outcomes and MeasuresThe primary outcome was the mean score for 4 subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS4) (range, 0-100, with higher scores indicating better knee function and fewer symptoms) at 12 months postoperatively. Secondary outcomes were patient-reported outcomes, graft maturity (on magnetic resonance imaging), and physical examinations at 3, 6, and 12 months.ResultsAmong the 120 randomized participants (mean [SD] age, 29.0 [8.0] years; 84 males [70%]), 114 (95%) were available for the primary outcome analysis. The mean KOOS4 scores at 12 months were 78.3 (SD, 12.0; 95% CI, 75.2-81.4) in the PRP group and 76.8 (SD, 11.9; 95% CI, 73.7-79.9) in the control group (adjusted mean between-group difference, 2.0; 95% CI, −2.3 to 6.3; P = .36). Secondary outcomes were not statistically significantly different between the 2 groups except for sports and recreation level and graft maturity at 6 months. Intervention-related adverse events included pain at the injection site and knee swelling after injection.Conclusions and RelevanceIn this randomized clinical trial among patients undergoing ACLR, the addition of postoperative intra-articular PRP injection did not result in superior improvement of knee symptoms and function at 12 months compared with no postoperative injection. Further studies are required to determine appropriate indications for PRP in musculoskeletal disorders.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2000040262

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Sonographically Guided Anterior Cruciate Ligament Injection: Technique and Validation

Cited by 12 publications

References 43 publications

Superb microvascular imaging (SMI) detects increased vascularity of the torn anterior cruciate ligament

Superb microvascular imaging (SMI) detects increased vascularity of the torn anterior cruciate ligament

Preoperative sonographic measurement can accurately predict quadrupled hamstring tendon graft diameter for ACL reconstruction

Intra-Articular Platelet-Rich Plasma Injection After Anterior Cruciate Ligament Reconstruction

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