Accuracy of talonavicular injection using ultrasound versus anatomical landmark: a cadaver study

Abstract

Background Intra-articular injections have diagnostic and therapeutic roles in foot and ankle pathologies due to complex anatomy, small size, diverse bones, and joints with proximity in this region. Conventionally, these injections are carried out using anatomical landmark technique and/or fluoroscopic guidance. The small joint space and needle size make the injection challenging. Fluoroscopy is not readily available in the clinical setting; ultrasound-guidance for injections is therefore increasingly being used. We compared the accuracy of intra-articular talonavicular injections using the anatomical landmark technique versus the ultrasound-guided method. Purpose To determine whether ultrasound guidance yields superior results in intra-articular injections of the talonavicular joint compared to injections using palpatory method guided by anatomical landmarks. Material and Methods The feet of 10 cadaveric specimens were held in neutral position by an assistant while a fellowship-trained foot-ankle orthopedic surgeon injected 2 cc of radiopaque dye using anatomical landmarks and palpation method in five specimens and under ultrasound guidance in the remaining five. The needles were left in situ in all specimens and their placement was confirmed fluoroscopically. Results In all five specimens injected under ultrasound guidance, the needle was found to be in the joint, whereas all five injected by palpation only were out of the joint, with one in the naviculo-cuneiform joint, showing ultrasound guidance to significantly increase the accuracy of intra-articular injections in the talonavicular joint than palpatory method alone. Conclusion Ultrasound-guided injections not only confirm correct needle placement, but also delineate any tendon and/or joint pathology simultaneously.

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part VI, foot and ankle

“…The use of US or fluoroscopy significantly improved the accuracy of injections into the tarsometatarsal joints [ 55 ]. A cadaveric study on talonavicular joint injection accuracy showed that the needle was correctly positioned in all US-guided injections, while it was misplaced in all cases of blind injections [ 57 ]. In juvenile idiopathic arthritis patients with ankle synovitis, image-guided intra-articular corticosteroid injections resulted in longer remission time when compared with palpation guidance [ 58 ].…”

Accuracy of Intraarticular Injections: Blind vs. Image Guided Techniques—A Review of Literature

“…The limited studies in the literature on TNJ and CCJ IAI accuracy also show improved results with ultrasound guidance. Jha et al, in a cadaveric study on TNJ IAI, found that all ultrasound-guided injections were successful, while all palpation-guided injections were unsuccessful [ 68 ]. Reach et al found the accuracy rates of TNJ and CCJ blind IAIs to be 50% and 60%, respectively [ 61 ].…”

Summary Report of the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society’s Symposium on Targets for Osteoarthritis Research: Part 1: Epidemiology, Pathophysiology, and Current Imaging Approaches

“…In several studies, ultrasonographic guidance has been found to be comparable to the criterion standard fluoroscopic guidance. 37,42,66 Platelet-rich plasma (PRP) injections have been considered a promising treatment for ankle (tibiotalar) OA. 56 The high interest is driven by the strong safety profile of PRP and promising results in the knee.…”

“…In several studies, ultrasonographic guidance has been found to be comparable to the criterion standard fluoroscopic guidance. 37,42,66…”