title: The posterolateral approach for fluoroscopy-guided tibiotalar joint injection.
abstract: OBJECTIVE
  To report a novel technique for tibiotalar joint injection that utilizes a posterolateral approach, including indications and technical considerations.
  
  
  METHODS
  The posterolateral approach for tibiotalar injection is similar to that used in posterior subtalar joint injections. Using this technique, the tibiotalar joint space is accessed by directing the needle anterosuperiorly beneath the fibula until the posterior aspect of the talar dome has been reached. A retrospective review was conducted of all posterolateral approach tibiotalar joint injections at our institution.
  
  
  RESULTS
  Eight patients underwent 12 technically successful therapeutic anesthetic/steroid tibiotalar joint injections using the posterolateral approach under fluoroscopic guidance. All eight patients had anterior predominant arthrosis with large osteophytes and tibiotalar joint space narrowing. The injections were well tolerated without evidence of complications.
  
  
  CONCLUSIONS
  Posterolateral tibiotalar joint injection offers an alternative to the more commonly used anterior approach, particularly in cases of severe anterior predominant arthrosis. An additional advantage of this technique is that the ankle stays in the same position between the initial planning of the needle trajectory and the visualization of contrast flowing into the joint.
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA. vanja.varenika@ucsf.edu.
authors.forename: Vanja
authors.initials: V
authors.lastname: Varenika
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Harter
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
authors.forename: Edwin
authors.initials: E
authors.lastname: Chu
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
authors.forename: Lynne
authors.initials: L
authors.lastname: Steinbach
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods*; D008297:Male; D008875:Middle Aged; D054850:Osteophyte / Q000000981:diagnostic imaging / Q000188:drug therapy; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage; D013380:Subtalar Joint / Q000000981:diagnostic imaging; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D013256:Steroids
keywords: Ankle; Arthrography; Injection; Posterolateral approach; Technique; Tibiotalar joint