Ultrasound-guided versus blind arthrocentesis in knee osteoarthritis: A systematic review and meta-Analysis

Abstract

Background: To summarize the current evidence about effectiveness and accuracy of using ultrasound-guided compared to blind arthrocentesis in the treatment of knee osteoarthritis. Methods: Web of Science, the Cochrane Central Register of Controlled Trials, EMBASE, Scopus, PubMed, ClinicalTrials.gov, Wangfang Database, and SinoMed were conducted from their inception to February 2024. Eligible studies included Randomized controlled trials (RCTs) and non-RCTs that compared the ultrasound-guided and blind arthrocentesis in knee osteoarthritis, with outcomes assessed base on pain, function, accuracy, and additional factors such as satisfaction, cost-effectiveness, fluid yield, and synovial membrane thickness. Results: Twenty-one studies that met the inclusion criteria (1924 patients) were identified. The results indicated that ultrasound-guided arthrocentesis was superior to blind arthrocentesis (10 trials; MD=-0.37; 95% CI=-0.55 to-0.19; P=.000). However, no significant difference was found in function improvement (7 trials; SMD=-0.60; 95% CI=-1.31 to 0.12; P=.101). Ultrasound-guided arthrocentesis also demonstrated better accuracy compared to blind arthrocentesis (RR=1.26, 95% CI: 1.09-1.46, P=.001). For satisfaction, the result reported ultrasound was better than the blind group (MD=1.11; 95% CI=0.67-1.54; P=.000) at immediate post-procedure, and at the 4 to 6 weeks (MD=0.98; 95% CI=0.56-1.41; P=.000). Conclusion: In the comprehensive systematic review and meta-Analysis of knee osteoarthritis, ultrasound-guided arthrocentesis is superior to anatomic landmark-guided arthrocentesis in terms of pain reduction and accuracy.