What is the proper approach for arthrocentesis of the ankle?

From the Guidelines

Arthrocentesis of the ankle should be performed using an approach that prioritizes accuracy and patient safety, with consideration of the joint, route of entry, and health professional expertise, as highlighted in the EULAR recommendations for intra-articular therapies 1. When performing arthrocentesis of the ankle, it is essential to consider the optimal setting, which includes a professional, clean, quiet, private, and well-lighted room, with the patient in an appropriate position, ideally on a couch or examining table, and equipment for aseptic procedures and resuscitation equipment close by 1.

• The patient must be fully informed of the nature of the procedure, the injectable, and potential benefits and risks, with informed consent obtained and documented according to local habits 1.
• The approach to the ankle joint should be guided by anatomical landmarks, with consideration of the use of imaging guidance, such as ultrasound, to improve accuracy, as several published systematic reviews and randomized controlled trials report that ultrasound improves accuracy in delivery of intra-articular therapies 1.
• The anterior approach is a commonly used method, which involves identifying the space between the tibialis anterior tendon and the extensor hallucis longus tendon, and inserting an 18-22 gauge needle perpendicular to the skin and directed toward the center of the joint space.
• After the procedure, patients should limit weight-bearing for 24-48 hours to allow the injection site to heal and maximize therapeutic benefit.
• It is crucial to note that the expertise of the health professional performing the procedure is essential, and aspiration of synovial fluid helps ensure that the needle is in the joint, as highlighted in the EULAR recommendations 1.

From the Research

Approach for Arthrocentesis of the Ankle

The proper approach for arthrocentesis of the ankle involves several key considerations:

• The procedure should be performed by a trained healthcare professional, as it requires precision and accuracy to avoid complications 2.
• The use of ultrasound assistance can be beneficial in locating the tibiotalar joint and increasing the probability of obtaining joint fluid on aspiration 3.
• Patients receiving anticoagulation therapy, including direct oral anticoagulants (DOACs), can undergo arthrocentesis and joint injection safely without the need to withhold anticoagulation treatment before the procedure 4.
• The procedure should be performed under sterile conditions to minimize the risk of infection.
• The healthcare professional should be prepared to analyze the collected fluid to establish a cause and inform appropriate management 2.

Key Considerations

• The safety and efficacy of arthrocentesis and joint injection have been established in various studies, including those involving patients with anticoagulation therapy 2, 4.
• The use of ultrasound assistance can help reduce the difficulty associated with performing ankle arthrocentesis 3.
• The procedure can provide significant, rapid, localized pain relief for patients 2.