Accuracy of anterolateral versus posterolateral subtalar injection

Tanja Kraus, Nima Heidari, Paul Borbas, Hans Clement, Wolfgang Grechenig, Annelie-Martina Weinberg
Archives of Orthopaedic and Trauma Surgery 2011, 131 (6): 759-63

INTRODUCTION: Injections into the subtalar joint may be performed for diagnostic or therapeutic reasons. The anterolateral approach is most commonly utilised for this purpose. We evaluated the success of an intra-articular puncture by using the anterolateral in comparison to the posterolateral approach.

METHODS: Sixty-eight cadaver adult feet were used for performing injections into the subtalar joint without fluoroscopic or ultrasound guidance. Methylene blue dye was infiltrated into 34 of the 68 subtalar joints through an anterolateral approach and into 34 through an posterolateral approach. An arthrotomy was then performed to confirm the placement of the dye within the joint.

RESULTS: Twenty-three of the anterolateral injections (67.6%) were successful as were 31 of 34 (91.2%) of the posterolateral. The posterolateral approach showed a greater accuracy with a statistically significance (p = 0.016).

CONCLUSION: Unintended peri-articular injection can cause complications and an unsuccessful aspiration can delay diagnosis. Comparing the anterolateral to the posterolateral approach with regards to the rate of successful intra-articular puncture of the subtalar joint without the use of imaging there is a greater accuracy with the PL with statistically significance.

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