Sonographically Guided Anterior Cruciate Ligament Injection: Technique and Validation

• Published in: PM & R Vol. 7; no. 7; pp. 736 - 745
• Main Authors: Smith, Jay, Hackel, Joshua G., Khan, Umar, Pawlina, Wojciech, Sellon, Jacob L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2015
• Subjects: Aged; Aged, 80 and over; Anterior Cruciate Ligament - diagnostic imaging; Anterior Cruciate Ligament Injuries; Cadaver; Female; Humans; Injections, Intra-Articular - methods; Knee Injuries - diagnostic imaging; Knee Injuries - drug therapy; Latex - administration & dosage; Male; Physical Medicine and Rehabilitation; Prospective Studies; Reproducibility of Results; Ultrasonography, Interventional - methods
• ISSN: 1934-1482; 1934-1563; 1934-1563
• DOI: 10.1016/j.pmrj.2015.01.014

To describe and validate a practical technique for sonographically guided anterior cruciate ligament (ACL) injections. Prospective, cadaveric laboratory investigation. Procedural skills laboratory in a tertiary medical center. Ten unembalmed, cadaveric mid–thigh-knee-ankle foot specimens (5 left knees and 5 right knees; 5 male and 5 female) from 10 donors aged 76 to 93 years (mean 85.6 years) with body mass indices of 17.6 to 42.2 kg/m2 (mean 28.8 kg/m2). A single, experienced operator used a 22-gauge, 63.5-mm stainless steel needle and a 12-3–MHz linear transducer to inject 1.5 mL of diluted colored latex into the ACLs of 10 unembalmed cadaveric specimens via an in-plane, caudad-to-cephalad approach, long axis to the ACL. At a minimum of 24 hours postinjection, specimens were dissected, and the presence and distribution of latex within the ACL assessed by a study co-investigator. Presence and distribution of latex within the ACL. All 10 injections accurately delivered latex into the proximal (femoral), midsubstance, and distal (tibial) portions of the ACL. No specimens exhibited evidence of needle injury or latex infiltration with respect to the menisci, hyaline cartilage, or posterior cruciate ligament. Sonographically guided intra-ligamentous ACL injections are technically feasible and can be performed with a high degree of accuracy. Sonographically guided ACL injections could be considered for research and clinical purposes to directly deliver injectable agents into the healing ACL postinjury or postreconstruction.