Article

There is a growing interest in the use of biologic agents such as
platelet-rich plasma and mesenchymal stem/stromal cells to treat musculoskeletal
injuries, including meniscal tears. Although previous research has documented the
role of diagnostic ultrasound to evaluate meniscal tears, sonographically guided
(SG) techniques to specifically deliver therapeutic agents into the meniscus have
not been described. OBJECTIVE: To describe and validate SG injection techniques
for the body and posterior horn of the medial and lateral meniscus. DESIGN:
Prospective, cadaveric laboratory investigation. SETTING: Academic institution
procedural skills laboratory. SUBJECTS: Five unenbalmed cadaveric knee-ankle-foot
specimens from 5 donors (3 female and 2 male) ages 33-92 years (mean age 74
years) with body mass indices of 21.1-32.4 kg/m(2) (mean 24.1 kg/m(2)). METHODS:
A single, experienced operator completed SG injections into the bodies and
posterior horns of the medial and lateral menisci of 5 unenbalmed cadaveric knees
using colored latex and a 22-gauge, 38-mm needle. After injection,
coinvestigators dissected each specimen to assess latex distribution within the
menisci and identify injury to intra-articular and periarticular structures. MAIN
OUTCOME MEASURES: Latex location within the target region of meniscus
(accurate/inaccurate), and iatrogenic injury to "at risk" intra- and
periarticular structures (present/absent). RESULTS: Seventeen of 20 injections
were accurate. Two of 3 inaccurate injections infiltrated the posterior horn of
the medial meniscus instead of the targeted meniscal body. One inaccurate lateral
meniscus injection did not contain latex despite sonographically accurate needle
placement. No specimen exhibited injury to regional neurovascular structures or
intra-articular hyaline cartilage. CONCLUSIONS: SG meniscus injections are
feasible and can accurately and safely deliver injectates such as regenerative
agents into bodies and posterior horns of the medial and lateral menisci. The
role of SG intrameniscal injections in the treatment of patients with
degenerative and traumatic meniscal disorders warrants further exploration. LEVEL
OF EVIDENCE: Not applicable.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS