Related Experiment Video
Updated: Jun 14, 2025
Author Spotlight: Minimally Invasive Ultrasound-Guided Acupotomy in Knee Osteoarthritis Treatment
Published on: April 26, 2024
Accuracy of ultrasound-guided knee injections confirmed by fluoroscopy
Caroline Varlotta1, Michael Harbus2, David Spinner3
1Department of Rehabilitation and Human Performance, Mount Sinai Hospital, New York, NY, USA.
Background:
Injection with viscosupplements is a common treatment for knee osteoarthritis. However, there is a lack of knowledge about how the injectate spreads within the knee following an injection.
Objective:
Using ultrasound and fluoroscopy, this study seeks to assess whether injectate introduced into the suprapatellar recess disperses into the tibiofemoral joint.
Design:
Descriptive case series and reliability test-retest study.
Setting:
Outpatient rehabilitation center at an academic teaching hospital.
Patients:
14 adults between 44 and 80 with knee osteoarthritis, defined as a grade 2-4 on the Kellgren and Lawrence scale, who were candidates for hyaluronic acid injections.
Interventions:
Participants received ultrasound guided knee injections into the suprapatellar recess with hyaluronic acid and contrast. Post-injection fluoroscopic images were taken. The participants then underwent a walking protocol. Post-walking fluoroscopic images were then taken.
Main Outcome Measurements:
Determining if an injectate introduced into suprapatellar recess localizes to the tibiofemoral joint following a walking test; and assessing interrater agreement with between 2 radiologists and 1 interventional physiatrist with regards to location of injectate.
Results:
Injectate placed in the suprapatellar recess using ultrasound-guided technique will disperse to a varying extent from the suprapatellar recess into the tibiofemoral or patellofemoral joint after a brief bout of walking. Images of US-guided knee injections identified by an experienced interventionalist to represent correct needle placement and injectate location, confirmed by reference-standard fluoroscopy, can be corroborated by a blinded radiologist and are therefore reliable.
Conclusions:
Fluoroscopic imaging confirmed that ultrasound-guided injection of hyaluronic acid into the suprapatellar recess dispersed into the tibiofemoral joint after a walking test. Future studies should examine whether the amount of injectate found in the tibiofemoral joint is correlated with patient outcomes.
Level Of Evidence:
Level IV.
