Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part V, knee
Luca Maria Sconfienza, Miraude Adriaensen, Domenico Albano, Andrea Alcalá‐Galiano, Georgina Allen, Maria Pilar Aparisi Gómez, Giacomo Aringhieri, Alberto Bazzocchi, Ian Beggs, Vito Chianca, Angelo Corazza, Danoob Dalili, Miriam De Dea, Jose Luis del Cura, Francesco Di Pietto, Eleni E. Drakonaki, Fernando Castro, Dimitrios Filippiadis, Salvatore Gitto, Andrew J. Grainger, Simon Greenwood, Harun Gupta, Amanda Isaac, Slavcho Ivanoski, Monica Khanna, Andrea Klauser, Ramy Mansour, Silvia Martin, Vasco Mascarenhas, Giovanni Mauri, Catherine McCarthy, David McKean, Eugene McNally, Kalliopi Melaki, Rebeca Mirón Mombiela, Ricardo Moutinho, Marina Obradov, Cyprian Olchowy, Davide Orlandi, R. Prada González, Mahesh Prakash, Magdalena Posadzy, Saulius Rutkauskas, Žiga Snoj, Alberto Tagliafico, Alexander Talaska, Xavier Tomàs, Violeta Vasilevska-Nikodinovska, Jelena Vucetic, David J. Wilson, Federico Zaottini, Marcello Zappia, Carmelo Messina
Abstract
OBJECTIVES: Interventional procedures around the knee are widely adopted for treating different musculoskeletal conditions. A panel of experts from the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the existing literature to assess the evidence on image-guided musculoskeletal interventional procedures around the knee, with the goal of highlighting some controversies associated with these procedures, specifically the role of imaging guidance, as well as the efficacy of the medications routinely injected. METHODS: We report the results of a Delphi-based consensus of 53 experts in musculoskeletal radiology, who reviewed the published literature for evidence on image-guided interventional procedures around the knee to derive a list of pertinent clinical indications. RESULTS: A list of 10 statements about clinical indications of image-guided procedures around the knee was created by a Delphi-based consensus. Only two of them had the highest level of evidence; all of them received 100% consensus. CONCLUSIONS: Ultrasonography guidance is strongly recommended for intra-articular and patellar tendinopathy procedures to ensure the precision and efficacy of these treatments. Prospective randomized studies remain warranted to better understand the role of imaging guidance and assess some of the medications used for interventional procedures around the knee. KEY POINTS: • A list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the knee was produced by an expert panel of the ESSR. • Strong consensus with 100% agreement was obtained for all statements. • Two statements reached the highest level of evidence, allowing us to strongly recommend the use of ultrasonography to guide intra-articular and patellar tendon procedures to ensure higher accuracy and efficacy of these treatments.