How to perform an ankle arthrocentesis (joint aspiration)?

From the Guidelines

To perform an ankle arthrocentesis, first obtain informed consent and gather necessary supplies, then position the patient supine with the ankle slightly elevated and externally rotated, and use imaging guidance, such as ultrasound, to improve accuracy and reduce complications, as recommended by recent studies 1.

Procedure Steps

• Obtain informed consent and gather necessary supplies including sterile gloves, povidone-iodine or chlorhexidine, sterile gauze, lidocaine 1%, syringes (5-10 mL), needles (18-22 gauge), and appropriate collection tubes.
• Position the patient supine with the ankle slightly elevated and externally rotated.
• Identify the appropriate entry site, typically the anteromedial or anterolateral approach between the tibialis anterior and extensor hallucis longus tendons.
• Clean the area with antiseptic solution in a circular motion and allow it to dry.
• Administer local anesthesia by injecting 2-3 mL of lidocaine 1% subcutaneously.
• Use imaging guidance, such as ultrasound, to insert the aspiration needle perpendicular to the skin and advance it into the joint space while applying gentle negative pressure on the syringe.
• Once synovial fluid appears, aspirate the required amount.
• Remove the needle, apply pressure with sterile gauze, and place a bandage over the site.
• Transfer the fluid immediately to appropriate collection tubes for analysis.

Importance of Imaging Guidance

• Imaging guidance, such as ultrasound, can improve accuracy and reduce complications, such as vascular injury or nerve damage, as reported in recent studies 1.
• The use of imaging guidance can also help to confirm the correct placement of the needle in the joint space.

Potential Complications

• Complications are rare but may include infection, bleeding, or pain at the injection site.
• The use of imaging guidance and proper technique can help to minimize the risk of complications.

Diagnostic Value

• Ankle arthrocentesis is essential for diagnosing conditions like septic arthritis, crystal arthropathies, or hemarthrosis by allowing direct examination of synovial fluid.
• The procedure can provide valuable diagnostic information, such as the presence of infection, inflammation, or crystal deposits, which can guide treatment decisions.

From the Research

Ankle Arthrocentesis Procedure

To perform an ankle arthrocentesis, the following steps can be considered:

• The procedure can be performed using a landmark technique or ultrasound guidance 2
• The use of ultrasound guidance has been shown to improve the accuracy and efficacy of the procedure 2
• A double syringe sterile system can be used to minimize the risk of iatrogenic infection 3
• The system consists of two syringes connected to a three-way infusion therapy device, allowing for a closed sterile system 3

Preparation and Technique

• The patient should be positioned in a way that allows easy access to the ankle joint
• The skin should be cleaned and disinfected before the procedure
• A local anesthetic can be used to numb the area before inserting the needle
• The needle should be inserted into the joint using a sterile technique, and the fluid should be aspirated before injecting any medication 4, 3

Considerations and Complications

• The procedure should be performed by a trained healthcare professional to minimize the risk of complications
• The risk of iatrogenic infection can be minimized by using a double syringe sterile system 3
• Other potential complications include nerve damage, bleeding, and infection 5, 6
• The use of ultrasound guidance can help to reduce the risk of complications by improving the accuracy of the procedure 2