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Ultrasound-Guided Knee Injections Are More Accurate Than Blind Injections: A Systematic Review of Randomized
William H Fang1, Xiao T Chen1, C Thomas Vangsness1
1Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A.
Purpose:
To review the current literature to determine which injection technique and needle portal placement provide the greatest accuracy for intra-articular access to the knee.
Methods:
This study followed Preferred Reporting Items and Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted in March 2020 and repeated in May 2020 using electronic databases PubMed, MEDLINE, and the Cochrane Library. Data on the accuracy of intra-articular knee injection (successful injections/total number of injections) were collected. Only Level I studies were included. Study design, demographic variables, needle sizes, and method of validating accuracy were recorded. The Jadad score was used to assess methodologic quality, and a risk-of-bias assessment was performed.
Results:
A total of 12 Level I human studies (1431 patients, 1315 knees) were included in this review. Seven of the studies did a direct comparison between ultrasound-guided and blind knee injections. Ultrasound-guided injections were more accurate compared with blinded knee injections in every study. The most accurate anatomical approach was an isometric quadricep contraction method with the superolateral approach.
Conclusions:
This study showed that ultrasound-guided knee injections were more accurate across every anatomical needle injection site compared with blind injections. Injections made by a blind/anatomically guided method had inconsistent accuracy rates that seemed highly dependent on the portal of entry.
Level Of Evidence:
Level I, systematic review of Level I studies.
