Precision and Safety of Ultrasound-Guided versus Palpation-Guided Needle Placement on the Patellar Tendon: A Cadaveric Study

Abstract

For decades, needling interventions have been performed based on manual palpation and anatomic knowledge. The increasing use of real-time ultrasonography in clinical practice has improved the accuracy and safety of needling techniques. Although currently ultrasound-guided procedures are routinely used for patellar tendon pathology, e.g., during percutaneous electrolysis, the accuracy of these procedures is still unknown. This study used a cadaveric model to compare and evaluate both the accuracy and safety of ultrasound-guided and palpation-guided needling techniques for the patellar tendon. A total of five physical therapists performed a series of 20 needle insertion task each (n = 100), 10 insertions based on manual palpation (n = 50) and 10 insertions guided with ultrasound (n = 50) to place a needle along the interface between the patellar tendon and Hoffa’s fat pad. All procedures were performed on cryopreserved knee specimens. Distance to the targeted tissue, time of the procedure, accurate rate of insertions, number of passes, and unintentional punctured structures between both applications (with and without ultrasound guiding) were compared. The results revealed higher accuracy (100% vs. 80%), a lower distance from needle to the targeted tissue (0.25 ± 0.65 vs. 2.5 ± 1.9 mm), longer surface of contact with the needle (15.5 ± 6.65 vs. 4.7 ± 7.5 mm), and a lower frequency of patellar tendon puncture (16% vs. 52%, p < 0.001) with the ultrasound-guided procedure as opposed to palpation-guided one. Nevertheless, the ultrasound-guided procedure took longer (54.8 ± 26.8 vs. 23.75 ± 15.4 s) and required more passes (2.55 ± 1.9 vs. 1.5 ± 0.95) to be conducted than the palpation-guided procedure (all, p < 0.001). According to these findings, the accuracy of invasive procedures applied on the patellar tendon is higher when conducted with ultrasound guidance than when conducted just on manual palpation or anatomical landmark. These results suggest that ultrasound could improve the clinical application of invasive procedures at the fat-patellar tendon interface. Due to the anatomical features of the targeted tissue, some procedures require this precision, so the use of ultrasound is recommended.

The Precision and Safety of Ultrasound-Guided versus Palpation-Guided Needle Placement on the Plantar Fascia and Flexor Digitorum Brevis Interface: An Anatomical Study

“…Nevertheless, to achieve this accuracy, the ultrasound-guided approach required significantly more time (mean: 53.8 ± 18.9 s) than the landmark-guided approach (mean: 19.1 ± 6.5 s). Again, these results are also similar to those in previous studies conducted on the knee [13] and elbow [24] regions. Differences in outcomes might occur since ultrasound guidance offers visual cues regarding needle placement, allowing therapists to refine and enhance their technique until reaching the exact target point, thus potentially prolonging the necessary time of the approach.…”

“…In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study. Arias-Buría et al [13] also found greater contact of the needle (mean: 15.5 ± 6.65 mm) on the targeted interphase than with the landmark-guided approach (mean: 0.25 ± 0.6 mm). Nevertheless, to achieve this accuracy, the ultrasound-guided approach required significantly more time (mean: 53.8 ± 18.9 s) than the landmark-guided approach (mean: 19.1 ± 6.5 s).…”

“…Thus, previous studies performed with a similar methodology but in other body areas such the knee [13] or the elbow [24] also yielded a higher accuracy with ultrasound-guided approaches. In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study. Arias-Buría et al [13] also found greater contact of the needle (mean: 15.5 ± 6.65 mm) on the targeted interphase than with the landmark-guided approach (mean: 0.25 ± 0.6 mm).…”

“…Previous studies using ultrasound-guidance approaches had attained accuracies ranging from 1.5 to 3.27 mm with different phantoms [17,22,23]. Thus, previous studies performed with a similar methodology but in other body areas such the knee [13] or the elbow [24] also yielded a higher accuracy with ultrasound-guided approaches. In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study.…”

The Precision and Safety of Ultrasound-Guided versus Palpation-Guided Needle Placement on the Plantar Fascia and Flexor Digitorum Brevis Interface: An Anatomical Study

“…Nevertheless, to achieve this accuracy, the ultrasound-guided approach required significantly more time (mean: 53.8 ± 18.9 s) than the landmark-guided approach (mean: 19.1 ± 6.5 s). Again, these results are also similar to those in previous studies conducted on the knee [13] and elbow [24] regions. Differences in outcomes might occur since ultrasound guidance offers visual cues regarding needle placement, allowing therapists to refine and enhance their technique until reaching the exact target point, thus potentially prolonging the necessary time of the approach.…”

“…In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study. Arias-Buría et al [13] also found greater contact of the needle (mean: 15.5 ± 6.65 mm) on the targeted interphase than with the landmark-guided approach (mean: 0.25 ± 0.6 mm). Nevertheless, to achieve this accuracy, the ultrasound-guided approach required significantly more time (mean: 53.8 ± 18.9 s) than the landmark-guided approach (mean: 19.1 ± 6.5 s).…”

“…Thus, previous studies performed with a similar methodology but in other body areas such the knee [13] or the elbow [24] also yielded a higher accuracy with ultrasound-guided approaches. In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study. Arias-Buría et al [13] also found greater contact of the needle (mean: 15.5 ± 6.65 mm) on the targeted interphase than with the landmark-guided approach (mean: 0.25 ± 0.6 mm).…”

“…Previous studies using ultrasound-guidance approaches had attained accuracies ranging from 1.5 to 3.27 mm with different phantoms [17,22,23]. Thus, previous studies performed with a similar methodology but in other body areas such the knee [13] or the elbow [24] also yielded a higher accuracy with ultrasound-guided approaches. In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study.…”

Percutaneous Electrolysis for Musculoskeletal Disorders Management in Rehabilitation Settings: A Systematic Review

“…PE administration under US guidance seems to be a valid option to raise its effectiveness and safety. US-guided invasive procedures are usually more precise, as also confirmed by cadaver studies [ 4 , 62 , 73 ]. US provides real-time visualization, allowing for precise needle placement within pathological tissue, which is crucial for delivering the galvanic current effectively and minimizing harm to surrounding healthy structures.…”

The Precision and Safety of Ultrasound-Guided versus Palpation-Guided Needle Placement on the Plantar Fascia and Flexor Digitorum Brevis Interface: An Anatomical Study

“…Nevertheless, to achieve this accuracy, the ultrasound-guided approach required significantly more time (mean: 53.8 ± 18.9 s) than the landmark-guided approach (mean: 19.1 ± 6.5 s). Again, these results are also similar to those in previous studies conducted on the knee [13] and elbow [24] regions. Differences in outcomes might occur since ultrasound guidance offers visual cues regarding needle placement, allowing therapists to refine and enhance their technique until reaching the exact target point, thus potentially prolonging the necessary time of the approach.…”

“…In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study. Arias-Buría et al [13] also found greater contact of the needle (mean: 15.5 ± 6.65 mm) on the targeted interphase than with the landmark-guided approach (mean: 0.25 ± 0.6 mm). Nevertheless, to achieve this accuracy, the ultrasound-guided approach required significantly more time (mean: 53.8 ± 18.9 s) than the landmark-guided approach (mean: 19.1 ± 6.5 s).…”

“…Thus, previous studies performed with a similar methodology but in other body areas such the knee [13] or the elbow [24] also yielded a higher accuracy with ultrasound-guided approaches. In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study. Arias-Buría et al [13] also found greater contact of the needle (mean: 15.5 ± 6.65 mm) on the targeted interphase than with the landmark-guided approach (mean: 0.25 ± 0.6 mm).…”

“…Previous studies using ultrasound-guidance approaches had attained accuracies ranging from 1.5 to 3.27 mm with different phantoms [17,22,23]. Thus, previous studies performed with a similar methodology but in other body areas such the knee [13] or the elbow [24] also yielded a higher accuracy with ultrasound-guided approaches. In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study.…”

Percutaneous Electrolysis for Musculoskeletal Disorders Management in Rehabilitation Settings: A Systematic Review

“…PE administration under US guidance seems to be a valid option to raise its effectiveness and safety. US-guided invasive procedures are usually more precise, as also confirmed by cadaver studies [ 4 , 62 , 73 ]. US provides real-time visualization, allowing for precise needle placement within pathological tissue, which is crucial for delivering the galvanic current effectively and minimizing harm to surrounding healthy structures.…”

The Precision and Safety of Ultrasound-Guided versus Palpation-Guided Needle Placement on the Plantar Fascia and Flexor Digitorum Brevis Interface: An Anatomical Study

“…Nevertheless, to achieve this accuracy, the ultrasound-guided approach required significantly more time (mean: 53.8 ± 18.9 s) than the landmark-guided approach (mean: 19.1 ± 6.5 s). Again, these results are also similar to those in previous studies conducted on the knee [13] and elbow [24] regions. Differences in outcomes might occur since ultrasound guidance offers visual cues regarding needle placement, allowing therapists to refine and enhance their technique until reaching the exact target point, thus potentially prolonging the necessary time of the approach.…”

“…In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study. Arias-Buría et al [13] also found greater contact of the needle (mean: 15.5 ± 6.65 mm) on the targeted interphase than with the landmark-guided approach (mean: 0.25 ± 0.6 mm). Nevertheless, to achieve this accuracy, the ultrasound-guided approach required significantly more time (mean: 53.8 ± 18.9 s) than the landmark-guided approach (mean: 19.1 ± 6.5 s).…”

“…Thus, previous studies performed with a similar methodology but in other body areas such the knee [13] or the elbow [24] also yielded a higher accuracy with ultrasound-guided approaches. In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study. Arias-Buría et al [13] also found greater contact of the needle (mean: 15.5 ± 6.65 mm) on the targeted interphase than with the landmark-guided approach (mean: 0.25 ± 0.6 mm).…”

“…Previous studies using ultrasound-guidance approaches had attained accuracies ranging from 1.5 to 3.27 mm with different phantoms [17,22,23]. Thus, previous studies performed with a similar methodology but in other body areas such the knee [13] or the elbow [24] also yielded a higher accuracy with ultrasound-guided approaches. In fact, Arias-Buría et al [13] also evaluated the accuracy of inserting a needle into the interface between the patellar tendon and Hoffa's fat pad and obtained similar results as in the current study.…”

Percutaneous Electrolysis for Musculoskeletal Disorders Management in Rehabilitation Settings: A Systematic Review

“…PE administration under US guidance seems to be a valid option to raise its effectiveness and safety. US-guided invasive procedures are usually more precise, as also confirmed by cadaver studies [ 4 , 62 , 73 ]. US provides real-time visualization, allowing for precise needle placement within pathological tissue, which is crucial for delivering the galvanic current effectively and minimizing harm to surrounding healthy structures.…”