From the Research
To perform an ankle joint aspiration, it is recommended to use ultrasound guidance, as it offers near-field visualization of the joint and soft tissues, ease of access, and lack of ionization radiation, as highlighted in the most recent study 1. When performing the procedure, the following steps should be taken:
- Obtain informed consent and gather necessary supplies including sterile gloves, povidone-iodine or chlorhexidine, sterile drapes, 18-22 gauge needle, 5-10 mL syringe, and appropriate collection tubes.
- Position the patient supine with the ankle slightly plantar flexed.
- Identify the appropriate entry site, typically the anterolateral approach between the lateral malleolus and extensor tendons, or the anteromedial approach between the medial malleolus and tibialis anterior tendon.
- Clean the area with antiseptic solution in a circular motion and allow it to dry.
- Apply sterile drapes around the site.
- Using sterile technique, insert the needle perpendicular to the skin and advance it into the joint space (typically 1-2 cm deep) under ultrasound guidance.
- Apply gentle suction while advancing to obtain synovial fluid.
- If no fluid returns, redirect slightly.
- Once fluid is obtained, collect the appropriate amount (typically 2-5 mL) and transfer to collection tubes.
- Remove the needle and apply pressure to the site for 2-3 minutes.
- Apply a sterile bandage.
- Send the fluid for appropriate testing including cell count, crystal analysis, Gram stain, culture, and other tests as clinically indicated. The use of ultrasound guidance is supported by recent studies 2, 1, 3, which demonstrate its effectiveness in improving the accuracy and safety of joint aspiration procedures. In terms of syringe size, a 10-mL syringe is recommended, as it generates sufficient vacuum while requiring less hand strength and providing better needle control, as shown in the study 4. Overall, the procedure should be performed with caution and attention to detail to minimize the risk of complications and ensure accurate diagnosis and treatment of ankle joint conditions.