State of the Art in Ultrasound-Guided Surgery: Concept, Planning, Instruments, Classifications, Indications, and Literature Review

Review Article | Volume 2 | Issue 1 | JRS Jan – Jun 2022 | Page 16-21 | Bernáldez Domínguez Pedro, Dallo Lazzarini Ignacio
DOI: 10.13107/jrs.2022.v02.i01.37

Author: Bernáldez Domínguez Pedro [1], Dallo Lazzarini Ignacio [1]

[1] Department of Orthopaedic Surgery and Sports Medicine, SportMe Medical Center, Unit of Biological Therapies and Ultrasounds, Seville, Spain.

Address of Correspondence
Dr. Bernáldez Domínguez Pedro, Md. PhD,
Tabladilla, 2, 41013, Seville, Spain.


Musculoskeletal ultrasound (MSK-U) and ultrasound-guided interventionism have had significant development and use in clinical practice in recent decades, including minimally invasive surgical procedures assisted by ultrasound. In the current literature, there is no consensus on the terminology of these procedures, with several terms used such as ultrasound-assisted surgery, ultrasound-guided surgery (UGS) or echo-guided surgery, sonosurgery, percutaneous ultrasound-guided procedures, and ultra-minimally invasive UGS. The MSK-U allows us to diagnose musculoskeletal injuries, but it is also a handy tool to assist us when performing different therapies on the tissues. They are procedures that require a good learning curve but that, once achieved, will allow us to develop other techniques depending on the type of pathology, obtaining good clinical results and in many cases avoiding having to open the focus or expand the surgical wound, with the advantages that this supposes. Therefore, UGS allows us to locate the exact site of the injury, understand the dynamics of the pathology; it does not need to open a wide surgical field, sometimes we will not put stitches or staples, and it can be combined with arthroscopic or endoscopic procedures (Ultrasound and Arthroscopic-guided Surgery). In this article, we describe the concept of UGS, its planning, the necessary instruments, the different indications, and a current concept review on the subject.

Keywords: Ultrasound-guided surgery, ultrasound-guided interventionism, ultrasound-assisted surgery, sonosurgery, ultrasound-arthroscopic surgery.


1. Domínguez B. The ultrasound: The stethoscope of the Traumatologist: Diagnostic and therapeutic utility. Rev Traum Ort 2017;34:17-26.
2. Vo JN, Hoffer Fa, Shaw DW. Pediatric image-guided nonvascular musculoskeletal interventions. Tech Vasc Interv Radiol 2010;13:214-21.
3. Sconfienza LM, Adriaensen M, Albano D, Alcala-Galiano A, Allen G, Gómez MB, et al. Clinical indications for image-guided interventional procedures in the musculoskeletal system: A Delphi-based consensus paper from the European society of musculoskeletal radiology (ESSR)-part V, knee. Eur Radiol 2022;32(3):1438-1447.
4. Dietrich CF, Goudie A, Chiorean L, Cui XW, Gilja OH, Dong Y, et al. Point of care ultrasound: A WFUMB position paper. Ultrasound Med Biol 2017;43:49-58.
5. Domínguez PB. Bridging the Gap between Surgical and Conservative Treatment. The SUBA Protocol (Sports, Ultrasound, Biologics, Arthroscopy). TOBI (The Orthobiologic Institute) Conference; 2021.
6. Goto K, Saku I. Ultrasound-guided arthroscopic communication enlargement surgery may be an ideal treatment option for popliteal cysts indications and technique. J Exp Orthop 2020;7:93.
7. Rojo-Manaute JM, Capa-Grasa A, Chana-Rodríguez F, Perez-Mañanes R, Rodriguez-Maruri G, Sanz-Ruiz P, et al. Ultra-minimally invasive ultrasound-guided carpal tunnel release: A randomized clinical trial. J Ultrasound Med 2016;35:1149-57.
8. Buncke G, McCormack B, Bodor M. Ultrasound-guided carpal tunnel release using the manos CTR system. Microsurgery 2013;33:362-6.
9. de la Fuente J, Miguel-Perez MI, Balius R, Guerrero V, Michaud J, Bong D. Minimally invasive ultrasound-guided carpal tunnel release: A cadaver study. J Clin Ultrasound 2013;41:101-7.
10. Lecoq B, Hanouz N, Vielpeau C, Marcelli C. Ultrasound-guided percutaneous surgery for carpal tunnel syndrome: A cadaver study. Joint Bone Spine 2011;78:516-8.
11. Apard T, Candelier G. Surgical ultrasound-guided carpal tunnel release. Hand Surg Rehabil 2017;36:333-7.
12. Smith J, Rizzo M, Lai JK. Sonographically guided percutaneous first annular pulley release: Cadaveric safety study of needle and knife techniques. J Ultrasound Med 2010;29:1531-42.
13. Yamamoto M, Kurimoto S, Okui N, Tatebe M, Shinohara T, Hirata H. Sonography-guided arthroscopy for wrist ganglion. J Hand Surg Am 2012;37:1411-5.
14. Peck E, Ely E. Successful treatment of de Quervain tenosynovitis with ultrasound-guided percutaneous needle tenotomy and platelet-rich plasma injection: Acase presentation. PM R 2013;5:438-41.
15. Sakellariou VI, Brault J, Rizzo M. Ultrasound-assisted percutaneous needle fasciotomy for Dupuytren’s contracture. Orthopedics 2015;38:299-303.
16. Willberg L, Sunding K, Forssblad M, Alfredson H. Ultrasound- and Doppler-guided arthroscopic shaving to treat Jumper’s knee: A technical note. Knee Surg Sports Traumatol Arthrosc 2007;15:1400-3.
17. Sunding K, Willberg L, Werner S, Alfredson H, Forssblad M, Fahlström M. Sclerosing injections and ultrasound-guided arthroscopic shaving for patellar tendinopathy: good clinical results and decreased tendon thickness after surgery-a medium-term follow-up study. Knee Surg Sports Traumatol Arthrosc 2015;23:2259-68.
18. Alfredson H. Ultrasound and Doppler-guided mini-surgery to treat midportion Achilles tendinosis: Results of a large material and a randomised study comparing two scraping techniques. Br J Sports Med 2011;45:407-10.
19. Alfredson H, Ohberg L, Zeisig E, Lorentzon R. Treatment of midportion Achilles tendinosis: Similar clinical results with US and CD-guided surgery outside the tendon and sclerosing polidocanol injections. Knee Surg Sports Traumatol Arthrosc 2007;15:1504-9.
20. Nasr P, Berman L, Rehm A. Ultrasonographic findings after Achilles tenotomy during ponseti treatment for clubfeet: Is ultrasound a reliable tool to assess tendon healing? J Child Orthop 2014;8:405-11.
21. Giannetti S, Patricola AA, Stancati A, Santucci A. Intraoperative ultrasound assistance for percutaneous repair of the acute Achilles tendon rupture. Orthopedics 2014;37:820-4.
22. Bisaccia M, Rinonapoli G, Meccariello L, Bisaccia O, Ceccarini P, Rollo G, et al. Validity and reliability of mini-invasive surgery assisted by ultrasound in achilles tendon rupture. Acta Inform Med 2019;27:40-4.
23. Severyns M, Andriamananaivo T, Rollet ME, Kajetanek C, Lopes R, Renard G, et al. Acute achilles tendon rupture: Ultrasonography and endoscopy-assisted percutaneous repair. Arthrosc Tech 2019;8:e489-93.
24. Lacoste S, Féron JM, Cherrier B. Percutaneous Tenolig(®) repair under intra-operative ultrasonography guidance in acute Achilles tendon rupture. Orthop Traumatol Surg Res 2014;100:925-30.
25. Debrule MB. Ultrasound-guided weil percutaneous plantar fasciotomy. J Am Podiatr Med Assoc 2010;100:146-8.
26. Yoo SH, Cha JG, Lee BR. Ultrasound-guided percutaneous bone drilling for the treatment of lateral epicondylitis. Eur Radiol 2018;28:390-7.
27. Koh JS, Mohan PC, Howe TS, Lee BP, Chia SL, et al. Fasciotomy and surgical tenotomy for recalcitrant lateral elbow tendinopathy: Early clinical experience with a novel device for minimally invasive percutaneous microresection. Am J Sports Med 2013;41:636-44.
28. Barnes DE, Beckley JM, Smith J. Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: A prospective study. J Shoulder Elbow Surg 2015;24:67-73.
29. Sconfienza LM, Mauri G, Messina C, Aliprandi A, Secchi F, Sardanelli F, et al. Ultrasound-guided percutaneous tenotomy of biceps tendon: Technical feasibility on cadavers. Ultrasound Med Biol 2016;42:2513-7.
30. Hirahara AM, Andersen WJ. Ultrasound-guided percutaneous reconstruction of the anterolateral ligament: Surgical technique and case report. Am J Orthop (Belle Mead NJ) 2016;45:418-60.
31. Delforge S, Lecoq B, Hulet C, Marcelli C. Coracoacromial ligament section under ultrasonographic control: A cadaveric study on 20 cases. Orthop Traumatol Surg Res 2014;100:e167-70.
32. Balius R, Bong DA, Ardèvol J, Pedret C, Codina D, Dalmau A. Ultrasound-guided fasciotomy for anterior chronic exertional compartment syndrome of the leg. J Ultrasound Med 2016;35:823-9.
33. Villanueva M, Iborra A, Sanz-Ruiz P, Noriega C. Ultrasound-guided surgery for lateral snapping hip: A novel ultraminimally invasive surgical technique. J Orthop Surg Res 2021;16:322.
34. Pilecki Z, Pilecki G, Ciekalski J, Dzielicki J, Jakubowski W. The advantages of combining sonotopogram with indication and fixation in invasive ultrasound. J Ultrason 2012;12:299-306.
35. Talbot M, Harvey EJ, Reindl R, Martineau P, Schneider P. Ultrasound-assisted external fixation: A technique for austere environments. J R Army Med Corps 2016;162:456-9.
36. Hardman HD, Smyth TW, Semo JJ, Rowan CC, DʼErcole FJ. Ultrasound-guided regional anesthesia and standard of care. Reg Anesth Pain Med 2018;43:107.
37. Souto MT, Fantoni DT, Hamaji A, Hamaji M, Vendruscolo CP, Otsuki DA, et al. Ultrasound-guided continuous block of median and ulnar nerves in horses: Development of the technique. Vet Anaesth Analg 2020;47:405-13.
38. Jobe CM, Zuckerman LM. Ultrasound-assisted posterior knee arthroscopy: A description of the technique. J Ultrasound Med 2021;40:1949-53.
39. Pilecki, Z, Koczy B, Mielnik M, Pilecki G, Dzielicki J, Jakubowski W. Basic dissecting techniques in ultrasound-guided surgery. J Ultrason 2014;14:171-8.
40. Finnoff JT, Hall MM, Adams E, Berkoff D, Concoff AL, Dexter W, et al. American medical society for sports medicine position statement: Interventional musculoskeletal ultrasound in sports medicine. Clin J Sport Med 2015;25:6-22.
41. Dallo I, Morales M, Gobbi A. Platelets and adipose stroma combined for the treatment of the arthritic knee. Arthrosc Tech 2021;10:e2407-14.
42. Dallo I, Szwedowski D, Mobasheri A, Irlandini E, Gobbi A. Aprospective study comparing leukocyte-poor platelet-rich plasma combined with hyaluronic acid and autologous microfragmented adipose tissue in patients with early knee osteoarthritis. Stem Cells Dev 2021.
43. Finnoff JT, Berkoff D, Brennan F, DiFiori J, Hall MM, Harmon K, et al. American medical society for sports medicine recommended sports ultrasound curriculum for sports medicine fellowships. Br J Sports Med 2015;49:145-50.


How to Cite this article: Pedro BD, Ignacio DL | State of the Art in Ultrasound-Guided Surgery: Concept, Planning, Instruments, Classifications, Indications, and Literature Review. | Journal of Regenerative Science | Jan – Jun 2022; 2(1): 16-21.

[Full Text HTML] [Full Text PDF] [XML]

0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *