Accuracy and efficacy of tibiotalar joint injections under ultrasound guidance: A systematic review
Mahmood Gharib1, Travis Cleland2,3, Veena Peraka4, Levent Özçakar5, Nitin B. Jain6
1Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN, USA
2Department of Physical Medicine and Rehabilitation, Crystal Clinic Orthopedic Center, Akron, OH, USA
3Department of Physical Medicine and Rehabilitation, Case Western Reserve School of Medicine, Cleveland, OH, USA
4Department of Physical Medicine and Rehabilitation, The University of Texas Southwestern, Dallas, TX, USA
5Department of Physical Medicine and Rehabilitation, Hacettepe University, Türkiye
6Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
Keywords: Ankle pain, arthrocentesis, fluoroscopy, image-guidance, injections, systematic review, tibiotalar, ultrasound.
Abstract
Objectives: In this systematic review, we assess the accuracy and effectiveness of ultrasound (US)-guided injections compared to alternative modalities for the treatment of tibiotalar joint.
Materials and methods: A systematic review was conducted following the Cochrane process from April 2023 to August 2023 utilizing PubMed, Ovid Embase, Web of Science, and Scopus. Branched logic was used to include articles containing terms regarding the tibiotalar joint, US and injections. Studies were screened for eligibility by two authors, and any disagreements were resolved through discussion with a third reviewer. Risk of bias assessments were performed.
Results: A total of five studies were included in the review, comparing various local delivery techniques for the treatment of tibiotalar joint. Three of these studies were cadaveric, while two studies were performed in surviving patients. In general, both the cadaveric studies and studies in surviving patients demonstrated increased accuracy of US-guided compared to landmark (LM)-guided injections of the tibiotalar joint. In a randomized-controlled trial of US-guided versus LM-guided injections in patients with inflamed joints, there was a greater improvement in pain control according to Visual Analog Scale (VAS) scores at six weeks (30.6 mm vs. 21.2 mm; p = 0.030). A retrospective study demonstrated 2.3 times greater success with image-guidance (US or fluoroscopy) compared to LM, with no significant difference between US and fluoroscopy (p = 0.09).
Conclusion: This systematic review provides evidence that US-guided injections demonstrate a higher level of accuracy as compared with LM-guided injections. However, risk of bias concerns, the limited number of included studies, particularly in vivo studies, and the lack of published, high-quality randomized-controlled trials investigating efficacy limit our ability to make definitive conclusions regarding clinical outcomes of US versus LM-guided tibiotalar injections.
Citation: Gharib M, Cleland T, Peraka V, Özçakar L, Jain NB. Accuracy and efficacy of tibiotalar joint injections under ultrasound guidance: A systematic review. Arch ISPRM 2026;1(2):99-105. https://doi.org/10.5606/archisprm.2026.31.
N.B.J., L.Ö.: Idea/concept; M.G., T.C., V.P., L.Ö., N.B.J.: Design, control/supervision, data collection and/or processing, analysis and/or interpretation, literature review, writing the article, critical review, references and fundings, materials.
The authors declare that there are no conflicts of interest with respect to the research, authorship, and/or publication of this article.
AI Disclosure
The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.
This research received no specific grant from any funding agency in the public, commercial, or not‑for‑profit sectors.
Data Availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.