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American Medical Society for Sports Medicine (AMSSM) position statement: interventional musculoskeletal ultrasound in sports medicine
  1. Jonathan T Finnoff1,2,
  2. Mederic M Hall3,
  3. Erik Adams4,
  4. David Berkoff5,
  5. Andrew L Concoff6,7,
  6. William Dexter8,9,
  7. Jay Smith10,11
  1. 1Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, Sacramento, California, USA
  2. 2Department of Physical Medicine and Rehabilitation, Mayo Clinic college of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA
  3. 3Department of Orthopedics and Rehabilitation, Department of Family Medicine, University of Iowa Sports Medicine, Iowa City, Iowa, USA
  4. 4Midwest Sports Medicine Institute, Middleton, Wisconsin, USA
  5. 5Department of Orthopaedics and Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
  6. 6Outpatient Musculoskeletal Rehabilitation, St. Jude Medical Center, Fullerton, California, USA
  7. 7Department of Family Medicine, Division of Sports Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
  8. 8Maine Medical Center, Portland, Maine, USA
  9. 9Tufts University School of Medicine, Boston, Massachusetts, USA
  10. 10Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA
  11. 11Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Jonathan T Finnoff, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Finnoff.jonathan{at}mayo.edu

Abstract

Background The use of diagnostic and interventional ultrasound has significantly increased over the past decade. A majority of the increased utilisation is by non-radiologists. In sports medicine, ultrasound is often used to guide interventions such as aspirations, diagnostic or therapeutic injections, tenotomies, releases and hydrodissections.

Objective Critically review the literature related to the accuracy, efficacy and cost-effectiveness of ultrasound-guided injections (USGIs) in major, intermediate and small joints; and soft tissues.

Design Systematic review of the literature.

Results USGIs are more accurate than landmark-guided injections (LMGIs; strength of recommendation taxonomy (SORT) Evidence Rating=A). USGIs are more efficacious than LMGIs (SORT Evidence Rating=B). USGIs are more cost-effective than LMGIs (SORT Evidence Rating=B). Ultrasound guidance is required to perform many new procedures (SORT Evidence Rating=C).

Conclusions The findings of this position statement indicate there is strong evidence that USGIs are more accurate than LMGI, moderate evidence that they are more efficacious and preliminary evidence that they are more cost-effective. Furthermore, ultrasound-guided (USG) is required to perform many new, advanced procedures and will likely enable the development of innovative USG surgical techniques in the future.

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