Ultrasound-guided infiltrative therapy of the knee

Abstract Purpose to determine the effectiveness of ultrasound guidance on needle placement accuracy, clinical outcomes and cost-effectiveness compared to intra- and peri-articular knee injections guided by anatomical landmarks. Materials and methods eleven experimental studies from the last 14 years (2011–2025) were selected on PubMed based on sample size and scientific rigor. Results needle placement accuracy ranged from 63 to 100% with ultrasound guidance and from 39 to 100% with conventional anatomical landmark guidance. Ultrasound guidance improved the accuracy of intra-articular knee injections compared to the exclusive use of anatomical landmarks (95–96% vs 78–83%, P < 0.001). Ultrasound guidance proved superior to anatomical landmark guidance especially in bursae and peritendinous injections, with an odds ratio of 6.4 (95% confidence interval [CI] 2.9–14). Lastly, ultrasound guidance ensured safety in procedures such as arthrocentesis, with a risk ratio of 1.21 (95% CI 1.13–1.29). Conclusions the greater injection accuracy achieved with ultrasound-guided needle placement—especially for knee tendon treatment—significantly improves clinical outcomes and cost-effectiveness.