Ultrasound-guided joint interventions of the lower extremity

Case Report: Portable handheld ultrasound facilitates intra-articular injections in articular foot pathologies

Background

Intra-articular injections are commonly used to manage joint pathologies, including osteoarthritis. While conventional ultrasound (US) guidance has generally improved intra-articular injection accuracy, forefoot and midfoot joint interventions are still often performed without imaging guidance. This pilot study aims to evaluate the efficacy of office-based, portable ultrasound (P-US) guided intra-articular injections for forefoot and midfoot joint pain caused by various degenerative pathologies.

Methods

A retrospective analysis was conducted on a series of consecutive patients who underwent P-US guided intra-articular injections following a chief complaint of forefoot or midfoot joint pain. Patients reported their pain levels using the Visual Analog Scale (VAS) pre-injection and at 3 months follow-up. The procedure was performed by an experienced foot and ankle surgeon using a linear array transducer for guidance, and a 25-gauge needle was used to inject a combination of 2 cc 1% lidocaine and 12 cc of Kenalog (40 mg/ml). Complications and pain scores were analyzed using a paired t-test and p < 0.05 was considered significant.

Results

We included 16 patients, 31% male and 69% female with a mean age (±SD) of 61.31 (±12.04) years. None of the patients experienced immediate complications following the intervention. The mean pre-injection VAS score was significantly reduced from 5.21 (±2.04) to a mean of 0.50 (±1.32) at 3 months follow-up (P < 0.001). Thirteen patients reported complete resolution of pain at the 3-month follow-up. No adverse events were reported throughout the duration of the study.

Conclusion

This pilot study suggests P-US-guided intra-articular injections offer a safe and effective method for managing forefoot and midfoot joint pain caused by various arthritic pathologies. Further research is warranted to establish the long-term efficacy and comparative effectiveness of P-US-guided injections in larger patient cohorts as compared to non-image guided injections.

Experimental Ultrasound Approach for Studying Knee Intra-Articular Femur-Tibia Movements under Different Loads

The purpose of the present study was to develop an experimental model for the study of intra-articular knee movements depending on the function of the knee joint and involved muscle groups under isometric stretching conditions with different loads. The experimental procedure included an ultrasound examination of a knee joint after isometric stretching in healthy men (n = 32). The changes (in millimeters) in the distances between the femur and tibia were measured using an ultrasound sonographer at three stages. The first stage was performed on ten (n = 10) healthy men in five different sitting and upright positions. In the second and third experimental model stages, lower limbs loading was applied to 22 participants. Our hypothesis, which was confirmed, was that as a result of increased loads on the participant's back, an intra-articular decrease in the femur-tibia cartilage surface distance would be observed. The accuracy of the created experimental model was improved over its three stages from 30% to 9%. Quantitative model data can help to create a mathematical model of the mechanical effects during the deformation of knee joint bone cartilage and it can also help outline some future tasks: increasing loading weights, enlarging participant groups, performing comparisons of men and women, and performing comparisons of healthy and pathological individuals.

Musculoskeletal Radiology Education: A National Survey by the Italian College of Musculoskeletal Radiology

BACKGROUND

Our aim was to understand how musculoskeletal training is structured in Italian residency programmes and the needs of young trainees.

METHODS

We sent out an online questionnaire (17 questions) to Italian Society of Radiology residents and board-certified radiologists aged up to 39 years.

RESULTS

A total of 1144 out of 4210 (27.2%) members participated in the survey; 64.7% were residents and 35.3% were board-certified radiologists. Just 26.6% of participants had dedicated rotations for musculoskeletal training during their residency, although this percentage substantially increased in replies from northern Italy. One-fourth of residents had a scheduled period of musculoskeletal ultrasound. Most participants (76.3%) had <20 h per year of musculoskeletal lessons. The majority considered their musculoskeletal education poor (57.7%) or average (21.9%). According to 84.8% of replies, no dedicated training period about interventional musculoskeletal procedures was scheduled. Further, just 12.8% of residents took active part in such interventions. Nearly all participants believed that the musculoskeletal programme during residency needs to be improved, particularly concerning practices in ultrasound (92.8%), MRI cases interpretation/reporting (78.9%), and practice in ultrasound-guided interventional procedures (64.3%).

CONCLUSIONS

Despite some differences in the structure of musculoskeletal education provided by different regions, there is a shared demand for improvement in musculoskeletal training.

Current and Novel Therapeutics for Articular Cartilage Repair and Regeneration

Articular cartilage repair is a sophisticated process that has is being recently investigated. There are several different approaches that are currently reported to promote cartilage repair, like cell-based therapies, biologics, and physical therapy. Cell-based therapies involve the using stem cells or chondrocytes, which make up cartilage, to promote the growth of new cartilage. Biologics, like growth factors, are also being applied to enhance cartilage repair. Physical therapy, like exercise and weight-bearing activities, can also be used to promote cartilage repair by inducing new cartilage growth and improving joint function. Additionally, surgical options like osteochondral autograft, autologous chondrocyte implantation, microfracture, and others are also reported for cartilage regeneration. In the current literature review, we aim to provide an up-to-date discussion about these approaches and discuss the current research status.