Accuracy and Efficacy of Intra-Articular Knee Injections/Aspirations Under Ultrasound versus Landmark Guidance: A Systematic Review

Purpose To review the current literature on the accuracy and efficacy of ultrasound (US)- and landmark (LM)-guided intra-articular knee injections. Methods A systematic review was performed following the Cochrane process from April 2023 to August 2023 utilizing PubMed, Embase, Web of Science, and Scopus. Branched logic was used to include articles containing terms regarding the knee AND ultrasound AND injections. Two authors screened studies for eligibility, and any disagreement was resolved through discussion with a third reviewer. Risk-of-bias assessments were performed. Results A total of 13 studies were included in the review. Cumulative accuracies amounted to 95.4% (356/373) versus 82.0% (268/327) for US-guided and LM-guided intra-articular knee injections/aspirations, respectively. All but one study looking at efficacy showed significantly improved outcomes in the US-guided injection/aspiration groups. Conclusions This systematic review provides data to support that US-guided intra-articular knee injections/aspirations are more accurate and efficacious than LM-guided intra-articular knee injections/aspirations. Level of Evidence Level I - systematic review.