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Surgical and Radiologic Anatomy

Published in:

23-01-2024 | Original Article

Ultrasound-guided injection of the ankle joint: cadaveric investigation of the anterolateral approach

Authors: Vincenzo Ricci, Kamal Mezian, Ke-Vin Chang, Kentaro Onishi, Murat Kara, Ondřej Naňka, Levent Özçakar

Published in: Surgical and Radiologic Anatomy | Issue 2/2024

Abstract

Objective

Injection of the tibiotalar (TT) joint is commonly performed in clinical practice under ultrasound (US) guidance using an anteromedial approach. However, in some patients, this approach may be technically challenging due to post-traumatic and/or degenerative bony changes. Therefore, the aim of this cadaveric investigation was to demonstrate the feasibility of the ultrasound-guided (USG) injection of the ankle joint via the anterolateral sulcus (ALS) by confirming the dye placement/distribution inside the articular space. Likewise, the safety of the procedure has also been evaluated by measuring the distance between the needle and the intermediate dorsal cutaneous nerve of the foot.

Design

A descriptive laboratory study with eight embalmed cadaveric ankles using the Fix for Life (F4L) method was performed at the setting of an academic institution. The interventional technique and the related anatomical findings were illustrated. During the injection, the needle was advanced into the TT joint through the ALS under US guidance, i.e., in-plane anterior-to-posterior approach. With the objective to confirm its correct placement, the needle was kept in situ and—to demonstrate the location of the dye inside the articular space—all eight ankles were injected with 3 mL of green color dye. Thereafter, a layer-by-layer anatomical dissection was performed on all four cadavers.

Results

The position of the needle’s tip within the ALS was confirmed in all specimens. Accurate placement of the dye inside the articular space of the ankle was confirmed in seven of the eight cadaveric ankles, with 87.5% of accuracy. Herewith, unintentional spilling of the dye within the superficial soft tissues was reported in two of the eight ankles (25.0%). The mean distance between the needle and the intermediate dorsal cutaneous nerve of the foot, measured in all eight procedures, was 3 cm.

Conclusion

USG injection of the ALS using the in-plane, anterior-to-posterior approach can accurately place the injectate inside the articular space.

Clinical relevance

This cadaveric investigation described the accuracy and potential pitfalls of USG injection of the ankle via the anterolateral approach which represents an alternative technique in patients with reduced accessibility of the anteromedial recess due to degenerative and/or post-traumatic bony changes.

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Title: Ultrasound-guided injection of the ankle joint: cadaveric investigation of the anterolateral approach
Authors: Vincenzo Ricci
Kamal Mezian
Ke-Vin Chang
Kentaro Onishi
Murat Kara
Ondřej Naňka
Levent Özçakar
Publication date: 23-01-2024
Publisher: Springer Paris
Published in: Surgical and Radiologic Anatomy / Issue 2/2024
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-023-03282-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Ultrasound-guided injection of the ankle joint: cadaveric investigation of the anterolateral approach

Abstract

Objective

Design

Results

Conclusion

Clinical relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Results

Conclusion

Clinical relevance

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