Ultrasound-guided accesses for regenerative injection therapy of hip and knee

Abstract

Interventional diagnostic and therapeutic technologies have gained considerable popularity in many surgical specialties – cardiology, vascular surgery, neurosurgery, oncology, and in orthopedics and traumatology. But unlike other specialties, ultrasound became the driving force behind the development and implementation of interventional technologies in the treatment of diseases of the musculoskeletal system. In recent years, ultrasound-guided injections have gained significant popularity, as they have given an advantage in accuracy compared to injections without such navigation. The purpose of our study was the development of ultrasound navigation accesses to the hip and knee joints for the interventional application of regenerative technologies in their pathology. The material for the study was the results of ultrasound examination of the hip and knee joints of 486 patients with diseases and injuries of the hip and knee, who were treated in the scientific and practical department of tissue and cell therapy of the State Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine in the period from 2016 to 2023. The results. The following accesses to the knee joint under ultrasound navigation have been developed: suprapatellar longitudinal access for injections into the quadriceps tendon and patellofemoral joint, suprapatellar longitudinal access with knee bending for injections into the upper turn of the knee joint, infrapatellar longitudinal access for injections into the patellar ligament and deep infrapatellar bursa, infrapatellar transverse access for injections into Hoffa’s fat pad, lateral longitudinal access with knee bending for injections into the lateral meniscus, medial longitudinal access with bending in the knee for injections in the medial meniscus, medial transverse access for injections in the medial part of the joint space, lateral transverse access with bending in the knee joint for injections in the lateral part of the joint space, lateral longitudinal access for performing injections in the collateral fibular ligament, medial longitudinal access for performing injections in the collateral tibial ligament, infrapatellar diagonal access for performing injections in the “crow’s foot” area of the knee joint, infrapatellar medial longitudinal access for performing other injection into the medial meniscus and joint capsule, lateral longitudinal access for injections into the tendons of the biceps femoris and hamstrings. The following accesses have been developed for the hip joint: anterior longitudinal access for performing injections in the subcapsular-cervical space, anterior diagonal access for performing injections in the acetabular labrum, capsule-ligament apparatus of the hip and tendon of the rectus femoris muscle, lateral longitudinal access for performing injections in the paratrochanteric region. Conclusions. 13 ultrasonic navigation accesses have been developed for the administration of biotechnological products into the knee joint and 3 – into the hip join, which allow not only to detect damaged intra-articular and para-articular structures of the knee and hip joints, but also to deliver an orthobiologics products directly to them for maximum regenerative effect.