Clinical Trials Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2022; 13(1): 78-86
Published online Jan 18, 2022. doi: 10.5312/wjo.v13.i1.78
Can bedside needle arthroscopy of the ankle be an accurate option for intra-articular delivery of injectable agents?
Tobias Stornebrink, Sjoerd A S Stufkens, Nathaniel P Mercer, John G Kennedy, Gino M M J Kerkhoffs
Tobias Stornebrink, Sjoerd A S Stufkens, Gino M M J Kerkhoffs, Department of Orthopedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam 1105AZ, Netherlands
Tobias Stornebrink, Sjoerd A S Stufkens, Gino M M J Kerkhoffs, Academic Center for Evidence based Sports Medicine, Amsterdam 1105AZ, Netherlands
Tobias Stornebrink, Sjoerd A S Stufkens, Gino M M J Kerkhoffs, Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center Amsterdam UMC, Amsterdam 1105AZ, Netherlands
Nathaniel P Mercer, John G Kennedy, Department of Orthopedic Surgery, NYU Langone Health, New York, NY 10010, United States
Author contributions: All authors have made substantial contributions to conception and design of the study, acquisition of data, or analysis and interpretation of data, drafting the article or making critical revisions related to important intellectual content of the manuscript, and final approval of the version of the article to be published.
Supported by Department of Orthopedic Surgery from the Amsterdam UMC was Supported with an Unrestricted Research Grant from Arthrex GmbH.
Institutional review board statement: The study was approved by our institutional ethical review board with reference 2019_203 and conducted in agreement with the 1964 Helsinki Declaration and its later amendments.
Clinical trial registration statement: Prior to the first inclusion, the study was registered at ToetsingOnline.nl with reference NL71185.018.19.
Informed consent statement: All patients provided written consent for their participation in the study prior to enrollment.
Conflict-of-interest statement: Dr. Kennedy reports consultancy fees from Arthrex, outside the submitted work.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gino M M J Kerkhoffs, MD, PhD, Full Professor, Department of Orthopedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam 1105AZ, Netherlands. g.m.kerkhoffs@amsterdamumc.nl
Received: May 8, 2021
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

Clinical accuracy and tolerability of this approach is not known.

Research objectives

To assess clinical accuracy and tolerability of bedside needle arthroscopy as a delivery system for injectable agents into the tibiotalar joint.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.