Aspiration of the ankle joint
Date First Published:
June 11, 2011
Last Updated:
June 17, 2011
Report by:
Richard Walter, Specialty Registrar (Torbay Hospital, Devon and Bristol Childrens’ Hospital)
Search checked by:
Natalie Roberts, Torbay Hospital, Devon and Bristol Childrens’ Hospital
Three-Part Question:
In the diagnosis of [patients with suspected septic arthritis of the ankle joint] is [the anteromedial or anterolateral approach] more likely to result in [successful needle aspiration of synovial fluid]?
Clinical Scenario:
A 30 year old male presents with 24 hours of right ankle pain, swelling and fever. You decide to perform needle aspiration of the ankle joint to diagnose a suspected septic arthritis.
Search Strategy:
Medline(R) 1948 to present and Embase 1980 to 2011 week 23 were searched on 11/6/2011.
Search Details:
Search terms were (ankle AND (aspirat$ OR injection)).ab,ti,tw.
LIMIT to human
LIMIT to human
Outcome:
630 papers were retrieved of which 629 were irrelevant.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Does the anteromedial or anterolateral approach alter the rate of joint puncture in injection of the ankle? Heidari N et al. Jan-10 Austria | 76 ankles from 38 cadavers. | Cadaveric. 76 ankles injected with methylene blue (36 anterolateral and 40 anteromedial). | 31 of 40 (77.5%) anteromedial and 31 of 36 (86%) anterolateral injections were succesful. | No significant difference in success rates between groups. | Cadaveric study. Not randomised. Successful injection may not necessarily relate to successful aspiration of a joint. |
Author Commentary:
The cadaveric study suggests that the anteromedial and anterolateral approaches have similar success rates of successful ankle joint puncture. A prospective randomised controlled trial would be helpful to determine whether these findings are also true for aspiration of the ankle joint in the emergency department setting.
Bottom Line:
There is no clinical evidence to support one approach over the other. Local guidelines should be followed.
References:
- Heidari N et al.. Does the anteromedial or anterolateral approach alter the rate of joint puncture in injection of the ankle?