Can bedside needle arthroscopy of the ankle be an accurate option for intra-articular delivery of injectable agents?

Autor: Stornebrink, Tobias, Stufkens, Sjoerd A. S., Mercer, Nathaniel P., Kennedy, John G., Kerkhoffs, Gino M. M. J.
Přispěvatelé: Graduate School, Orthopedic Surgery and Sports Medicine, AMS - Ageing & Vitality, AMS - Sports
Rok vydání: 2022
Předmět:
Zdroj: World journal of orthopedics, 13(1), 78-86. di xue qian yuan bian ji bu
World Journal of Orthopaedics, 13(1), 78-86. di xue qian yuan bian ji bu
World Journal of Orthopedics
Stornebrink, T, Stufkens, S A S, Mercer, N P, Kennedy, J G & Kerkhoffs, G M M J 2022, ' Can bedside needle arthroscopy of the ankle be an accurate option for intra-articular delivery of injectable agents? ', World Journal of Orthopaedics, vol. 13, no. 1, pp. 78-86 . https://doi.org/10.5312/wjo.v13.i1.78
ISSN: 2218-5836
Popis: BACKGROUND Bedside needle arthroscopy of the ankle under local anesthesia has been proposed for intra-articular delivery of injectable agents. Accuracy and tolerability of this approach in the clinical setting-including patients with end-stage ankle pathology and/or a history of prior surgery-is not known. AIM To assess clinical accuracy and tolerability of bedside needle arthroscopy as a delivery system for injectable agents into the tibiotalar joint. METHODS This was a prospective study that included adult patients who were scheduled for an injection with hyaluronic acid to the tibiotalar joint. In our center, these injections are used as a last resort prior to extensive surgery. The primary outcome was injection accuracy, which was defined as injecting through the arthroscopic cannula with intra-articular positioning confirmed by a clear arthroscopic view of the joint space. Secondary outcome measures included a patient-reported numeric rating scale (NRS, 0-10) of pain during the procedure and willingness of patients to return for the same procedure. NRS of ankle pain at rest and during walking was collected at baseline and at 2-wk follow-up. Complications were monitored from inclusion up to a 2-wk control visit. RESULTS We performed 24 inspection-injections. Eleven (46%) participants were male, and mean age was 46.8 ± 14.5 years. Osteoarthritis was the indication for injection in 20 (83%) cases, of which 8 (33%) patients suffered from osteoarthritis Kellgren-Lawrence grade IV, and 10 (42%) patients from Kellgren-Lawrence grade III. An osteochondral defect was the indication for injection in 4 (17%) cases. A history of ankle surgery was present in 14 (58%) participants and a history of multiple ankle surgeries in 11 (46%) participants. It was possible to confirm accuracy in 21 (88%) procedures. The 3 (12%) participants where needle arthroscopy did not reach a clear view of the joint space all suffered from Kellgren-Lawrence grade IV osteoarthritis. Pain during the procedure was reported with a median of 1 [interquartile ranges (IQR): 0-2]. Willingness to return was 100%. Pain in rest decreased from a median NRS of 4 (IQR: 2-7) at baseline to a median of 3 (IQR: 1-5) at follow-up (P < 0.01). Pain during walking decreased from a median NRS of 8 (IQR: 6-9) to a median of 7 (IQR: 4-8) (P < 0.01). Infections or other complications were not encountered. CONCLUSION Clinical accuracy and tolerability of bedside needle arthroscopy of the ankle as a delivery system for injectable agents are excellent. Accuracy was 100% in patients without total ventral joint obliteration.
Databáze: OpenAIRE
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