Published online Jan 18, 2022. doi: 10.5312/wjo.v13.i1.78
Peer-review started: May 8, 2021
First decision: October 16, 2021
Revised: November 15, 2021
Accepted: December 31, 2021
Article in press: December 31, 2021
Published online: January 18, 2022
Processing time: 253 Days and 19.1 Hours
Needle arthroscopy is rapidly attracting the interest of the orthopedic field, as recent technical innovation has increased image quality and improved surgical handling. Bedside needle arthroscopy of the ankle under local anesthesia has been proposed for intra-articular delivery of injectable agents.
Clinical accuracy and tolerability of this approach is not known.
To assess clinical accuracy and tolerability of bedside needle arthroscopy as a delivery system for injectable agents into the tibiotalar joint.
A prospective clinical study was conducted. Adult patients who were scheduled for an injection to the ankle joint were included. The primary outcome was accuracy of bedside needle arthroscopic injections under local anesthesia. Additionally, a patient reported numeric rating scale (NRS, 0-10) of pain during the procedure and willingness of patients to return for a similar procedure if needed were recorded. Occurrence of complications was monitored from inclusion up to a 2-wk control visit.
Of 24 inspection-injections were performed. Osteoarthritis was the indication for injection in 20 (83%) cases–of which 8 cases (33%) were Kellgren-Lawrence grade IV, and 10 cases (42%) were Kellgren-Lawrence grade III. The indication was an osteochondral defect in 4 (17%) participants. Fourteen (58%) participants had a history of ankle surgery and 11 (46%) patients a history of multiple ankle surgeries. It was possible to confirm accuracy in 21 (88%) procedures. The 3 (12%) participants where this confirmation failed all suffered from Kellgren-Lawrence grade IV osteoarthritis. Participants reported a NRS of pain during the procedure with a median of 1 (interquartile ranges: 0–2), and a willingness to return of 100%. We did not encounter infections or other complications.
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.
The results of this study may form the groundwork for further expansion of indications that merit needle arthroscopy of the ankle under local anesthesia, including operative procedures.