title: 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.
authors.affiliation: Department of Orthopedics, University of North Carolina School of Medicine, Chapel Hill, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Berkoff
authors.forename: Larry E
authors.initials: LE
authors.lastname: Miller
authors.forename: Jon E
authors.initials: JE
authors.lastname: Block
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage; D016001:Confidence Intervals; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007270:Injections, Intra-Articular / Q000191:economics* / Q000379:methods*; D007719:Knee Joint / Q000000981:diagnostic imaging*; D009339:Needles; D016017:Odds Ratio; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000191:economics; D011859:Radiography; D015203:Reproducibility of Results; D018084:Ultrasonography, Interventional / Q000191:economics* / Q000379:methods*
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D006820:Hyaluronic Acid