Ultrasound‐Guided Perimeniscal Injections

Abstract

Objectives To anatomically describe the ultrasound (US)‐guided perimeniscal injection technique, and evaluate its feasibility in the treatment of meniscal pain. Methods This work was initially undertaken in four cadaveric specimens with US‐guided medial and lateral perimeniscal injection of China ink, followed by cadaveric dissection to assess injectate distribution, and potential injury to intra‐articular and peri‐articular structures. Then, 35 consecutive patients who underwent US‐guided perimeniscal corticosteroid injection under local anesthesia for the treatment of symptomatic medial (30/35) or lateral (5/35) degenerative meniscal tear were retrospectively evaluated. Clinical outcome was assessed using a 0–10 numerical verbal rating scale (VRS) to evaluate severity of pain before, during, and after procedure at 6 weeks follow‐up. Results Seven of eight (87.5%) ex vivo injections were accurate. A single inaccurate medial perimeniscal injection infiltrated the tibial collateral ligament instead of the perimeniscal area. No anatomical specimen exhibited intrameniscal injection or injury to regional structures. All procedures (35/35) performed clinically were technically successful. Median VRS scores were: 7 (range, 3–9) before procedure, 5 (range, 0–10) during procedure, and 1.5 (range, 0–9) after procedure at 6 weeks follow‐up (P <.0001). No complication was observed. Conclusions US‐guided perimeniscal injections can accurately and safely deliver injectates in the perimeniscal area. In addition, our data suggest that perimeniscal corticosteroid injection provides significant symptom relief at 6 weeks in patients with meniscal pain. Further studies with long‐term follow‐up will be required to evaluate the role of perimeniscal injections in the nonoperative management of meniscal pathology.