Clinical utility of ultrasound guidance for intra-articular knee injections: a review

Figures & data

Table 1 Assessment of study characteristics

Reference	Joint Pathology	Procedure	Imaging modality	Randomization	Blinding	Accurate injection definition
Balint at al^Citation15	Knee RA, seronegative arthritis, OA	Fluid aspiration	US	No	Outcome assessor	Removal of a recordable amount of synovial fluid
Bliddal^Citation17	Knee OA	Air injection	Air arthrography	No	No	Injected air visible in suprapatellar pouch
Cunnington et al^Citation19	Knee Inflammatory arthritis	Corticosteroid injection	US	Yes	Patient, clinical assessor, radiologic assessor	Radiography of joint in two planes performed immediately after injection
Curtiss et al^Citation20	Knee Cadaveric, no pathology	Dye injection	US	Yes	Outcome assessor	All injectate found within joint upon dissection
Im et al^Citation21	Knee OA	HA injection	US	Yes	No	Radiographic evaluation after injection confirming all contrast material in the intra-articular space
Park et al^Citation26	Knee OA	HA injection	US	Yes	Outcome assessor	Radiographic evaluation after injection confirming all contrast material in the intra-articular space
Bain et al^Citation14	Shoulder (AC) Shoulder girdle symptoms	Corticosteroid injection	Fluoroscopy	No	No	Joint distension during injection identified with dynamic fluoroscopic images
Bisbinas et al^Citation16	Shoulder (AC) NR	NR	Fluoroscopy	No	No	Needle location between bony boundaries of acromion and clavicle
Catalano et al^Citation18	Shoulder (GH) NR	NR	MR arthrography	No	No	Absence of contrast extravasation under MR imaging
Cunnington et al^Citation19	Shoulder (GH) Inflammatory arthritis	Corticosteroid injection	US	Yes	Patient, clinical assessor, and radiologic assessor	Radiography of joint in two planes performed immediately after injection
Peck et al^Citation23	Shoulder (AC) Cadaveric, no pathology	Colored latex injection	US	Yes	Outcome assessor	All latex found entirely within the acromioclavicular joint upon dissection
Pichler et al^Citation24	Shoulder (AC) Cadaveric, no pathology	Methyl blue injection	Fluoroscopy	No	No	Intra-articular solution injection confirmed via arthrotomy
Rutten et al^Citation22	Shoulder (SB) Impingement syndrome	Corticosteroid injection	MRI	Yes	Outcome assessor	Confirmation of all injection fluid within subacromial-subdeltoid bursa via MRI
Sabeti-Aschraf et al^Citation25	Shoulder (AC) Cadaveric, no pathology	Needle infiltration	US	Yes	Outcome assessor	Acromioclavicular joint exhibits remarkable widening of the joint space or swelling under ultrasound imaging

Abbreviations: AC, acromioclavicular; GH, glenohumeral; HA, hyaluronic acid; IA, intra-articular; MRI, magnetic resonance imaging; NR, not reported; OA, osteoarthritis; RA, rheumatoid arthritis; SB, subacromial bursa; US, ultrasound.

Table 2 Controlled studies of imaging-guided intra-articular knee and shoulder injection accuracy

Reference	Joint Pathology	Needle placement accuracy (%)
		Image-guided	No imaging
Balint et al^Citation15	Knee RA, seronegative arthritis, OA	94.7 (18 of 19)	40.0 (4 of 10)
Bliddal^Citation17	Knee OA	100 (56 of 56)	91.1 (51 of 56)
Cunnington et al^Citation19	Knee Inflammatory arthritis	91.4 (32 of 35)	81.8 (27 of 33)
Curtiss et al^Citation20	Knee Cadaveric, no pathology	100 (40 of 40)	77.5 (31 of 40)
Im et al^Citation21	Knee OA	95.6 (43 of 45)	77.3 (34 of 44)
Park et al^Citation26	Knee OA	96.0 (48 of 50)	83.7 (41 of 49)
Bain et al^Citation14	Shoulder (AC) Shoulder girdle symptoms	100 (44 of 44)	54.5 (24 of 44)
Bisbinas et al^Citation16	Shoulder (AC) NR	100 (66 of 66)	39.4 (26 of 66)
Catalano et al^Citation18	Shoulder (GH) NR	100 (147 of 147)	85.0 (125 of 147)
Cunnington et al^Citation19	Shoulder (GH) Inflammatory arthritis	63.2 (12 of 19)	40.0 (8 of 20)
Peck et al^Citation23	Shoulder (AC) Cadaveric, no pathology	100 (10 of 10)	40.0 (4 of 10)
Pichler et al^Citation24	Shoulder (AC) Cadaveric, no pathology	100 (20 of 20)	56.6 (43 of 76)
Rutten et al^Citation22	Shoulder (SB) Impingement syndrome	100 (10 of 10)	100 (10 of 10)
Sabeti-Aschraf et al^Citation25	Shoulder (AC) Cadaveric, no pathology	95.0 (57 of 60)	71.7 (43 of 60)

Abbreviations: AC, acromioclavicular; GH, glenohumeral; OA, osteoarthritis; RA, rheumatoid arthritis; SB, subacromial bursa.

Table 3 Needle placement accuracy of controlled studies of imageguided intra-articular knee and shoulder injection accuracy

Joint	Needle placement accuracy (%)		P value*
	Image-guided	No imaging
Knee
All imaging modalities	96.7 (237 of 245)	81.0 (188 of 232)	<0.001
US only	95.8 (181 of 189)	77.8 (137 of 176)	<0.001
Shoulder
All imaging modalities	97.3 (366 of 376)	65.4 (283 of 433)	<0.001
US only	88.8 (79 of 89)	61.1 (55 of 90)	<0.001

Note:

* Fisher’s Exact test.

Abbreviation: US, ultrasound.

Figure 1 Accuracy of ultrasound guidance for intra-articular knee injections: forest plot of controlled studies.

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