Ultrasound-Guided Perimeniscal Injections: Anatomical Description and Feasibility Study.
anatomy
knee
meniscus
ultrasound
Journal
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
ISSN: 1550-9613
Titre abrégé: J Ultrasound Med
Pays: England
ID NLM: 8211547
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
revised:
12
02
2021
received:
16
10
2020
accepted:
08
03
2021
pubmed:
1
4
2021
medline:
21
12
2021
entrez:
31
3
2021
Statut:
ppublish
Résumé
To anatomically describe the ultrasound (US)-guided perimeniscal injection technique, and evaluate its feasibility in the treatment of meniscal pain. This work was initially undertaken in four cadaveric specimens with US-guided medial and lateral perimeniscal injection of China ink, followed by cadaveric dissection to assess injectate distribution, and potential injury to intra-articular and peri-articular structures. Then, 35 consecutive patients who underwent US-guided perimeniscal corticosteroid injection under local anesthesia for the treatment of symptomatic medial (30/35) or lateral (5/35) degenerative meniscal tear were retrospectively evaluated. Clinical outcome was assessed using a 0-10 numerical verbal rating scale (VRS) to evaluate severity of pain before, during, and after procedure at 6 weeks follow-up. Seven of eight (87.5%) ex vivo injections were accurate. A single inaccurate medial perimeniscal injection infiltrated the tibial collateral ligament instead of the perimeniscal area. No anatomical specimen exhibited intrameniscal injection or injury to regional structures. All procedures (35/35) performed clinically were technically successful. Median VRS scores were: 7 (range, 3-9) before procedure, 5 (range, 0-10) during procedure, and 1.5 (range, 0-9) after procedure at 6 weeks follow-up (P <.0001). No complication was observed. US-guided perimeniscal injections can accurately and safely deliver injectates in the perimeniscal area. In addition, our data suggest that perimeniscal corticosteroid injection provides significant symptom relief at 6 weeks in patients with meniscal pain. Further studies with long-term follow-up will be required to evaluate the role of perimeniscal injections in the nonoperative management of meniscal pathology.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
217-224Informations de copyright
© 2021 American Institute of Ultrasound in Medicine.
Références
Messner K, Gao J. The menisci of the knee joint. Anatomical and functional characteristics, and a rationale for clinical treatment. J Anat 1998; 193:161-178.
Fox AJ, Wanivenhaus F, Burge AJ, Warren RF, Rodeo SA. The human meniscus: a review of anatomy, function, injury, and advances in treatment. Clin Anat 2015; 28:269-287.
Yim JH, Seon JK, Song EK, et al. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med 2013; 41:1565-1570.
Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 2013; 369:2515-2524.
Gauffin H, Sonesson S, Meunier A, Magnusson H, Kvist J. Knee arthroscopic surgery in middle-aged patients with meniscal symptoms: A 3-year follow-up of a prospective, randomized study. Am J Sports Med 2017; 45:2077-2084.
Beaufils P, Pujol N. Management of traumatic meniscal tear and degenerative meniscal lesions. Save the meniscus. Orthop Traumatol Surg Res 2017; 103:S237-S244.
Byrne C, Alkhayat A, Bowden D, Murray A, Kavanagh EC, Eustace SJ. Degenerative tears of the posterior horn of the medial meniscus: correlation between MRI findings and outcome following intra-articular steroid/bupivacaine injection of the knee. Clin Radiol 2019; 74:488.e1-488.e8.
Rastogi AK, Davis KW, Ross A, Rosas HG. Fundamentals of joint injection. AJR Am J Roentgenol 2016; 207:484-494.
Lalam RK, Winn N, Cassar-Pullicino VN. Interventional articular and para-articular knee procedures. Br J Radiol 2016; 89:20150413.
Lee JH, Lee JU, Yoo SW. Accuracy and efficacy of ultrasound-guided pes anserinus bursa injection. J Clin Ultrasound 2019; 47:77-82.
Wilderman I, Berkovich R, Meaney C, Kleiner O, Perelman V. Meniscus-targeted injections for chronic knee pain due to meniscal tears or degenerative fraying: a retrospective study. J Ultrasound Med 2019; 38:2853-2859.
Di Sante L, Venditto T, Ioppolo F, Paoloni M, Mangone M, Alviti F. Ultrasound guided injection of a painful knee osteoarthritis with medial meniscus extrusion: a case series study. Muscles Ligaments Tendons J 2017; 18:331-337.
Ricci V, Özçakar L, Galletti L, Domenico C, Galletti S. Ultrasound-guided treatment of extrusive medial meniscopathy: A 3-step protocol. J Ultrasound Med 2020; 39:805-810.
Chevrier A, Nelea M, Hurtig MB, Hoemann CD, Buschmann MD. Meniscus structure in human, sheep, and rabbit for animal models of meniscus repair. J Orthop Res 2009; 27:1197-1203.
Abrams GD, Frank RM, Gupta AK, Harris JD, McCormick FM, Cole BJ. Trends in meniscus repair and meniscectomy in the United States, 2005-2011. Am J Sports Med 2013; 41:2333-2339.
Salata MJ, Gibbs AE, Sekiya JK. A systematic review of clinical outcomes in patients undergoing meniscectomy. Am J Sports Med 2010; 38:1907-1916.
Herrlin SV, Wange PO, Lapidus G, et al. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc 2013; 21:358-364.
Stein G, Koebke J, Faymonville C, Dargel J, Müller LP, Schiffer G. The relationship between the medial collateral ligament and the medial meniscus: a topographical and biomechanical study. Surg Radiol Anat 2011; 33:763-766.
Baria MR, Sellon JL, Lueders D, Smith J. Sonographically guided knee meniscus injections: feasibility, techniques, and validation. PMR 2017; 9:998-1005.
Mine T, Kimura M, Sakka A, Kawai S. Innervation of nociceptors in the menisci of the knee joint: an immunohistochemical study. Arch Orthop Trauma Surg 2000; 120:201-204.
Englund M, Roemer FW, Hayashi D, Crema MD, Guermazi A. Meniscus pathology, osteoarthritis and the treatment controversy. Nat Rev Rheumatol 2012; 22:412-419.
Katz JN, Smith SR, Yang HY, et al. Value of history, physical examination, and radiographic findings in the diagnosis of symptomatic méniscal tear among middle-aged subjects with knee pain. Arthritis Care Res (Hoboken) 2017; 69:484-490.