Table 2.

Pearls and Pitfalls of Intraosseous Injections

Pearls

Mapping of the wire trajectory should be performed using fluoroscopy before incisions are made.

When approaching the subchondral bone, the surgeon should use the fluoroscopic view in which the wire appears closer to the cortex he or she is targeting (AP or lateral view).

Thrombin should be used to activate bone marrow aspirate concentrate whenever possible.

Aspiration should be performed before biologics are slowly injected in the intraosseous space.

Pitfalls

Because of the small capacity of the intraosseous space, some of the injected biologic may flow back out of the needle.

It can be difficult to accurately target lesions seen on MRI but not on fluoroscopy.

Patients may experience some pain when undergoing the WALANT technique.

AP, anteroposterior; MRI, magnetic resonance imaging; WALANT, wide-awake limited anesthesia no tourniquet.