RPS 610 - Imaging in action: musculoskeletal interventions

Author Block: M. Adinolfi Falcone, L. Rinvenuto, F. Arrigoni, L. Zugaro, A. Barile, E. Di Cesare; L'Aquila/IT
Purpose: Platelet-rich plasma (PRP) and hyaluronic acid (HA) are established intra-articular therapies.
This study aimed to compare the short- and long-term efficacy of PRP with a corticosteroid–HA combination in patients with knee osteoarthritis.
Methods or Background: A retrospective single-center study was conducted on 100 patients under 60 years of age (mean age 51) with knee osteoarthritis classified according to the International Cartilage Repair Society (ICRS). Patients were divided into two groups: Group A received three intra-articular PRP injections at 2-week intervals; Group B received one intra-articular corticosteroid injection followed by two HA injections at the same intervals. Symptom severity was assessed using the Visual Analog Scale (VAS) at baseline and at 1, 3, 6, and 12 months. Statistical analysis was performed, with p<0.05 considered significant.
Results or Findings: Baseline VAS scores were comparable between groups. At 1 month, corticosteroid–HA showed greater early symptom relief (VAS decrease: 4.30 ± 2.31, p<0.001). At 3 months, no significant difference was observed (p=0.860). PRP demonstrated slower onset but superior long-term efficacy at 6 and 12 months (VAS decrease: 5.56 ± 1.50, p<0.001). Within the corticosteroid–HA group, subgroup analysis by ICRS grade demonstrated more durable effects in grades I–II, whereas grades III–IV showed improvement limited to the short-term.
Conclusion: PRP injections provided significantly greater long-term symptom relief compared with corticosteroid–HA. While PRP showed slower onset, its efficacy was sustained up to 12 months. Corticosteroid–HA offered more transient benefits, with duration influenced by baseline ICRS grade. These findings support PRP as a more effective long-term treatment option for knee osteoarthritis.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
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Author Block: D. Alatefi¹, M. Alkabazi², A. Alanzi³, B. L. Alsaleh³, M. Amro⁴, A. Hezam³; ¹Amman/JO, ²Tripoli/LY, ³Manama/BH, ⁴Bad Wildungen/DE
Purpose: Efficacy of platelet-rich plasma (PRP) versus corticosteroid injections for facet and sacroiliac joint pain.
Methods or Background: PubMed, Cochrane Library, Scopus, Embase, Web of Science, CINAHL Complete, Virtual Health Library, ClinicalTrials.gov, and ScienceDirect were searched up to 21 June 2025. Mean pain scores changes from baseline to first, third, and sixth months using a scale of 10 scores (0= no pain, and 10= worst pain). Secondary outcome was disability using Oswestry Disability Index (ODI) or Modified ODI (MODQ). Data pooled using mean difference (MD) for pain scores outcome, and standardized mean difference (SMD) for disability outcome. Random-effects meta-analysis performed using ‘Meta’ package in R (RStudio version 4.4.3), with subgroup analyses by joint (facet vs SIJ) to facilitate further interpretation.
Results or Findings: Ten RCTs (six facet, and four SIJ) enrolling 392 patients (mean age 46.8 years, 50.6% male) were included. At one month, pain outcomes favored PRP but did not reach statistical significance (MD -0.23, 95% CI -1.07 to 0.61; p = 0.589; I² = 90.6%). At three months, PRP significantly reduced pain versus corticosteroids (MD -1.42, 95% CI -2.12 to -0.71; p < 0.001), with consistent benefit across facet and SIJ subgroups. Superiority persisted at six months (MD -2.00, 95% CI -3.13 to -0.87; p = 0.0005). Disability outcome showed no significant difference at one month (SMD 0.26, 95% CI -0.30 to 0.82), but PRP significantly improved function at three months (SMD -0.72, 95% CI -1.56 to -0.25; p = 0.0052) and at six months in facet trials (SMD -1.80, 95% CI -3.16 to -0.45; p = 0.009).
Conclusion: PRP provides superior medium- and long-term pain and functional improvement compared with corticosteroid injections for facet and SIJ pain.
Limitations: Heterogeneity in PRP preparation and corticosteroid regimens.
Funding for this study: This research received no external funding
Has your study been approved by an ethics committee? Not applicable
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Author Block: O. Fındık Şener, F. Sage, E. H. Niks, S. S. Rauh, M. C. De Ruiter, M. A. Engelse, N. Geijsen, M. C. Burgmans, H. E. Kan; Leiden/NL
Purpose: Duchenne muscular dystrophy is characterized by progressive muscle wasting. Current gene-editing trials using systemic delivery face challenges in systemic side effects and tissue exposure. Intramuscular dosing may increase tissue concentrations and limit side effects, but requires an optimal injection technique.
We aim to develop ultrasound-guided intramuscular delivery and MRI monitoring of fluid distribution in a preclinical setting.
Methods or Background: Dose-escalation and repeatability were assessed in two sets of four porcine extensor digitorum brevis muscles in situ. Four volumes (2.5-10ml of an ink and iTOP (induced transduction by osmocytosis and propanebetaine) solution (dilution 1/10) were injected using a 20G Chiba needle under ultrasound guidance. The entire muscle was targeted longitudinally from four directions. Muscle volume and ink distribution (%stained vs total) were quantified on 2cm cross-sections. Repeatability was assessed with the intraclass correlation-coefficient (ICC).
In four other porcine hindlimbs, fluid distribution was quantified using 3T MRI, pre and post-injection scans (pixel-intensity threshold method on the TSE Dixon water-only image (TE=94ms)). 2.5 and 5ml injections are completed so far, with 7.6 and 10ml expected to be completed by March 2026.
Results or Findings: Muscle volumes were 26.9±4.1cm3. The injection to volume ratio was 0.1; 0.2; 0.3 and 0.3 (2.5ml to 10ml). In the dose-escalation experiment, higher injection volumes showed increased fluid distribution (ranging from 54.8% for 2.5ml to 99.4% for 10ml). Repeatability was excellent with an ICC of 0.99. Post-injection MR images showed a clear increase in signal intensity, with up to 65% elevated pixels.
Conclusion: Ultrasound-guided four longitudinal intramuscular injections provided up to 99.4% fluid distribution and excellent consistency between the measurements. MRI enabled in-situ monitoring of fluid distribution, suggesting that this method can also be used in-vivo.
Limitations: The limitation of the study is having non-living models.
Funding for this study: Funding was provided by the Novo Nordisk Foundation Center for Stem Cell Medicine (reNEW), (Grant number NNF21CC0073729)
Has your study been approved by an ethics committee? Not applicable
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Author Block: G. Kalidonis, V. Nikovia, E. A. EZERSKA, K. Demetriou, M. Klontzas, M. Raissaki, A. Karantanas, E. E. Vassalou; Heraklion/GR
Purpose: To compare the efficacy of ultrasound-guided subacromial-subdeltoid (SASD) bursa platelet-rich plasma (PRP) and corticosteroid injections in patients with SASD bursitis over 1-year and to assess the predictive value of several factors related to outcome.
Methods or Background: From January 2021 to November 2023, consecutive patients with SASD bursitis secondary to shoulder impingement syndrome (SIS) were prospectively enrolled. Patients with rotator cuff tendinosis/tears were excluded. Participants were randomly assigned into two groups, (i)PRP-group receiving a single, ultrasound-guided SASD bursa injection with 10mL of autologous PRP (n=41) and (ii)corticosteroid-group, receiving a 10mL mixture of triamcinolone acetonide, lidocaine and saline (n-42). Clinical outcomes were assessed using the Constant-Murley Score (CMS) at baseline, 1-week, 3-months, 6-months, and 1-year post-treatment. Statistical analyses were performed using the Mann-Whitney and Hosmer-Lemeshow tests. A multivariable logistic regression model was developed to ascertain the effect of six factors on CMS. P<.05 denoted significance.
Results or Findings: The PRP-group included 26-females/15-males (mean age, 43.4 years) and the corticosteroid-group 24-females/18-males (mean age, 42.3 years). Baseline CMS showed no significant difference (p=.11). In both groups CMS improved significantly at all time-points compared to baseline (p<.05). At 6-months no significant difference was observed (p=.076); the corticosteroid-arm showed improved outcome at all other time-points (p<.05). Treatment method and maximum bursa width were significant predictors for achieving patient acceptable symptom state at 3-months while patient age and baseline CMS were significant at 1-year.
Conclusion: Both corticosteroids and PRP appeared effective for SASD bursitis, with results sustained up to 1-year. PRP achieved comparable effect in the mid-term. Corticosteroids showed superior outcome at other time-points. These findings support PRP as an alternative therapeutic option for SIS-related SASD bursitis.
Limitations: CMS, although widely accepted, presents certain drawbacks as a clinical tool for evaluating functional capacity.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
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Author Block: G. Reverchon, A. Bazzocchi, F. Ponti, G. Bilancia, D. Romeo, P. Spinnato; Bologna/IT
Purpose: Flare-ups of chronic Achilles tendinopathy (AT) represent a therapeutic challenge. Conservative options may fail, while surgery is often too invasive. We present our initial experience with a novel ultrasound-guided interventional procedure – the triple-target “sandwich” technique – designed to manage AT flare-ups in a minimally invasive manner.
Methods or Background: Between January and June, 7 procedures were performed on 5 patients with chronic AT flare-ups (2 women, 3 men; mean age 50 years). Under ultrasound guidance, with previous subcutanous and peritendinous tissue local anestesia, injections were performed at three levels: (1) intratendinous tissue with hyperosmolar glucose, (2) pre-Achilles bursa with anesthetic and triamcinolone, and (3) retro-Achilles bursa with anesthetic and water-soluble corticosteroid. Prolotherapy works by injecting an hyperosmolar glucose solution that mildly irritates the tissue, stimulating the body’s natural healing response. This helps the body produce new collagen, making the tendons stronger and reducing the pain.Patients were subsequently referred for rehabilitation. Pain scores (NRS) and range of motion (complete restoration, subtotal, partial and unchanged) were assessed at baseline, 1 week, 3 months, and 6 months.
Results or Findings: Mean pain scores significantly decreased from 8.8 at baseline to 1.5 at 1 week, 0.8 at 3 months, and 3.1 at 6 months (p=0.002). At 3-month follow-up, 42% of patients achieved complete recovery of motion, 42% subtotal recovery, and 14% partial recovery. At 6 months, complete recovery was maintained in 28%, subtotal in 28%, and partial in 42%. No complications or adverse events were reported.
Conclusion: The ultrasound-guided triple-target “sandwich” technique appears to be a safe, well-tolerated, and cost-effective procedure for the management of AT flare-ups. Despite the limitations of a small sample and short follow-up, these preliminary findings suggest promising clinical potential.
Limitations: Small patient cohort and limited follow-up.
Funding for this study: No funding was provided.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: local IRB approval obtained.

Author Block: S. Mandal¹, D. Dalili²; ¹London/UK, ²Oxford/UK
Purpose: To assess outcomes of CT-guided facet joint cyst rupture over five years, focusing on surgical avoidance and the need for subsequent operative management.
Methods or Background: Facet joint cysts, a sequela of degenerative spinal disease, may produce nerve compression and pain. While surgical excision remains standard, CT-guided cyst rupture offers a minimally invasive alternative, with reported surgical avoidance rates of 55–66%. We retrospectively reviewed all patients undergoing CT-guided cyst rupture at Epsom Hospital (2020–2025). Follow-up data were derived from spinal surgeon clinic records. Of 35 cases identified, 14 were excluded (no cyst at procedure, spontaneous resolution, incomplete follow-up, or technical failure), leaving 21 patients for analysis.
Results or Findings: The cohort comprised 10 men (47%) and 11 women (53%), mean age 68 years. Most cysts were at L4/L5 (76%). Ten patients (48%) underwent an indirect approach; 11 (52%) received combined indirect and direct techniques. Eight patients (38%) required surgery (completed or scheduled), with a mean interval of 85 days post-rupture. Thirteen patients (62%) avoided surgery; of these, five (24%) required additional interventions (epidural or Racz catheter), while eight (38%) required no further treatment and derived sustained benefit.
Conclusion: CT-guided facet joint cyst rupture is a safe, effective, and minimally invasive treatment, with 62% avoiding surgery and over a third achieving durable relief without further intervention. These outcomes align with published data, supporting its consideration as a first-line option, particularly for patients at elevated surgical risk or preferring less invasive management.
Limitations: Small sample size, heterogenous follow-up, and retrospective design. We are still collecting data for a larger study to assess validation, generalisability and reproducibility.
Funding for this study: Not applicable
Has your study been approved by an ethics committee? Not applicable
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Author Block: R. Marcello, G. Marcello, M. Cuccarelli; Roma/IT
Purpose: To evaluate the clinical indications, technical approaches, and outcomes of two interventional radiology techniques—genicular artery embolization (GAE) and genicular nerve ablation (GNA)—in the management of chronic knee pain following total knee arthroplasty (TKA).
Methods or Background: We conducted a retrospective cohort analysis of patients with chronic (>3 months) post-TKA knee pain unresponsive to conservative treatment. Patients underwent either GAE, GNA, or a sequential combined approach.
• GAE: performed under fluoroscopic guidance and microcatheter 1.7 Fr. superselective embolization of hyperemic genicular branches. Vascular approach was antegrade percutaneous US-guided common femoral artery access in most cases whereas controlateral cross over access was indicated in obese patients or in case of others anatomical limitations.
• GNA: performed using radiofrequency ablation of the superomedial, superolateral, and inferomedial genicular nerves after a diagnostic nerve block. A dedicated RF generator was applied.
Pain relief was assessed via VAS score at baseline and during follow-up (1, 3, and 6 months), along with functional improvement (WOMAC) and complication rates.
Results or Findings: • Total patients: 13 (GAE n=8 GNA n=2; combined n=3)
• Mean pain reduction (VAS at 3 months):
o GAE: –3.5 points
o GNA: –4.1 points
o Combined: –5.2 points
• Functional improvement (WOMAC): significant in all groups (p<0.01), particularly in the combined group.
• Complications: no major complications observed; minor side effects included transient skin discoloration (GAE) and local paresthesia (GNA).
• Technical success: 100% in all procedures.
Conclusion: GAE and GNA are safe and effective image-guided procedures for chronic pain management after TKA, each addressing different pain mechanisms (inflammatory vs. neuropathic). Combined approaches may offer enhanced pain relief in selected cases. These minimally invasive techniques represent promising alternatives to revision surgery.
Limitations: Any
Funding for this study: Any
Has your study been approved by an ethics committee? Not applicable
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Author Block: A. M. Delgado Brito, J. D. Aquerreta, I. Soriano, M. Elorz Carlón, M. Jiménez Vázquez, D. A. Zambrano, M. R. López De La Torre Carretero, A. Paternain Nuin; Pamplona/ES
Purpose: To evaluate the safety and feasibility of ultrasound-guided botulinum toxin type A (BTX-A) injection into the lateral abdominal wall as a preoperative adjunct for abdominal wall hernia repair, with attention to anatomy, technique, and outcomes.
Methods or Background: Consecutive case series of 23 patients. Abdominal wall anatomy was reviewed to guide infiltration of the lateral abdominal muscles (external oblique, internal oblique, transversus abdominis), which contribute to retraction and tension of the hernia defect. Under ultrasound guidance, 3–5 injection sites per side were used, tailored to abdominal wall dimensions. A total dose of 500 IU was diluted and evenly distributed across target muscles. The median interval from injection to surgery was 29 days. Patients were followed for hernia recurrence and procedure-related adverse events.
Results or Findings: Mean age 61.4 ± 12.3 years; mean body mass index (BMI) 28.9 ± 3.6 kg/m². Most patients (22/23; 95.7%) had at least one risk factor (smoking, diabetes, chronic obstructive pulmonary disease (COPD), or overweight). The procedure was well tolerated, with no major BTX-A–related complications. After a median follow-up of 881 days, no hernia recurrences were observed, including in two patients operated <48 hours after injection.
Conclusion: Ultrasound-guided BTX-A injection of the lateral abdominal wall is a safe, minimally invasive, and reproducible preoperative technique. By inducing temporary muscle relaxation, it facilitates fascial closure and optimizes repair. In this series, no medium-term recurrences were observed despite multiple comorbidities, supporting further comparative studies.
Limitations: The limitations of the study are its small sample size and the absence of a control group. Subsequent studies should enroll larger cohorts and incorporate a suitable control arm to improve robustness and generalizability.
Funding for this study: No funding was received for this study.
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