Ambrose J. Huang MD, Presenter: Nothing to Disclose

Connie Y. Chang MD, Abstract Co-Author: Nothing to Disclose

Frank J. Simeone MD, Abstract Co-Author: Nothing to Disclose

Martin Torriani MD, Abstract Co-Author: Nothing to Disclose

Miriam Antoinette Bredella MD, Abstract Co-Author: Nothing to Disclose

Susan V. Kattapuram MD, Abstract Co-Author: Nothing to Disclose

William E. Palmer MD, Abstract Co-Author: Nothing to Disclose

To compare the newer lateral mortise and more traditional anterior approaches to fluoroscopically guided tibiotalar joint steroid injections with respect to fluoroscopy time and radiation dose.

For this IRB-approved, HIPAA-compliant, retrospective study, the study population consisted of all patients referred to the MSK Division for fluoroscopically guided tibiotalar joint steroid injections from 11/1/2010-12/31/2013. Images were reviewed on a PACS workstation to determine the injection approach (lateral mortise vs anterior) and to confirm intra-articular adminstration of injectate. Fluoroscopy time (minutes), radiation dose (mGy), and dose area product (uGy-m^2) were recorded. Their means and standard deviations were calculated and compared using student t-tests. P < 0.05 was considered statistically significant.

246 patients underwent the lateral mortise approach, and 252 underwent the anterior approach. 4 patients were excluded from the lateral mortise group because a) no contrast was administered due to the patient's contrast allergy (n=2), b) injectate was mostly extra-articular (n=1), or the joint could not be accessed due to severe osteoarthritis (n=1). Mean fluoroscopy time was 0.7±0.5 minutes n the lateral mortise group and 1.2±0.8 minutes in the anterior group (P<0.0001). Mean radiation dose was 2.1±3.7 mGy in the lateral mortise group and 2.5 ± 3.5 mGy in the anterior group (P=0.2400). Mean dose area product was 11.5±15.3 μGy-m2 in the lateral mortise group and 13.5 ± 17.3 μGy-m2 in the anterior group (P=0.1739).

The lateral mortise approach for fluoroscopically guided tibiotalar joint injection requires statistically significantly less fluoroscopy time than the anterior approach (approximately 40% less). Radiation dose and dose area product were also on average less for the lateral mortise approach than the anterior approach, though these did not reach statistical significance.

Both the lateral mortise and the anterior approaches are effective methods of performing fluoroscopically guided tibiotalar joint injections. Knowledge of both techniques increases the likelihood of success when performing these injections, since one approach or another may be superior for a particular patient. The lateral mortise approach requires approximately 40% less fluoroscopy time and is technically easier to perform and to teach compared to the anterior approach.

Huang, A, Chang, C, Simeone, F, Torriani, M, Bredella, M, Kattapuram, S, Palmer, W, Comparing the Lateral Mortise Approach and the Anterior Approach to Fluoroscopically Guided Tibiotalar Joint Injections.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004601.html