The posterolateral approach for fluoroscopy-guided tibiotalar joint injection

Objective To report a novel technique for tibiotalar joint injection that utilizes a posterolateral approach, including indications and technical considerations. Methods The posterolateral approach for tibiotalar injection is similar to that used in posterior subtalar joint injections. Using this technique, the tibiotalar joint space is accessed by directing the needle anterosuperiorly beneath the fibula until the posterior aspect of the talar dome has been reached. A retrospective review was conducted of all posterolateral approach tibiotalar joint injections at our institution. Results Eight patients underwent 12 technically successful therapeutic anesthetic/steroid tibiotalar joint injections using the posterolateral approach under fluoroscopic guidance. All eight patients had anterior predominant arthrosis with large osteophytes and tibiotalar joint space narrowing. The injections were well tolerated without evidence of complications. Conclusion Posterolateral tibiotalar joint injection offers an alternative to the more commonly used anterior approach, particularly in cases of severe anterior predominant arthrosis. An additional advantage of this technique is that the ankle stays in the same position between the initial planning of the needle trajectory and the visualization of contrast flowing into the joint.