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Arthroscopic Assessment of Landmark-Guided Knee Injection Accuracy: A Prospective Observational Study
Yusuf Altuntas1, Enver Ipek, Bahadır Balkanlı
1Department of Orthopedic and Traumatology, Health Science University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
American Journal of Physical Medicine & Rehabilitation
|June 15, 2026
Summary
Landmark-guided knee injections show a high rate of inaccuracy, with over 27% of placements being suboptimal. While operator experience improves accuracy, limitations persist, especially in patients with obesity.
Area of Science:
- Orthopedic Surgery
- Diagnostic Imaging Techniques
Background:
- Landmark-guided knee injections are common but their accuracy is debated.
- Imaging guidance is often used to improve precision.
Purpose of the Study:
- To arthroscopically evaluate the accuracy of landmark-guided knee injections.
- To assess the impact of operator experience on injection accuracy and time.
Main Methods:
- Prospective observational study of 162 patients undergoing knee arthroscopy.
- Anterolateral "soft spot" approach used for landmark-guided injections.
- Intra-articular needle placement verified arthroscopically.
Main Results:
- 72.8% of injections were accurately placed intra-articularly.
- Accuracy increased with operator experience (53.2% to 87.0%).
- Higher BMI (≥30 kg/m²) was associated with significantly lower accuracy.
Conclusions:
- Landmark-guided knee injections have a substantial rate of suboptimal placement.
- Operator experience improves accuracy and reduces procedure time.
- Limitations of landmark guidance are evident, particularly in patients with altered anatomy.
