Ultrasound-Guided Versus Landmark-Guided Injection in Knee Osteoarthritis: A Comparative Study of Pain Trajectory, Functional Recovery, and Treatment Durability

Abstract

Background: Intra-articular injections are a mainstay of conservative management in knee osteoarthritis (OA). Accuracy of needle placement affects clinical outcomes, and ultrasound (US) guidance has been proposed as superior to conventional landmark-guided injection. Objective: To compare pain trajectory, functional recovery, and treatment durability between ultrasound-guided and landmark-guided intra-articular corticosteroid injections in patients with symptomatic knee OA. Methods: A prospective, randomized, single-blinded comparative study was conducted on 120 patients (60 per group) with Kellgren–Lawrence grade II–III knee OA. Outcomes were assessed at baseline, 2, 6, 12, and 24 weeks using the Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne Index. Results: The US-guided group showed significantly greater reductions in VAS and WOMAC scores at all follow-up intervals, with a longer duration of symptomatic relief and fewer procedural complications (p < 0.05). Conclusion: Ultrasound guidance improves accuracy, magnitude, and durability of therapeutic response in knee OA injections and should be preferred where feasible.