A comparative study comparing area of extension of posterior knee capsule via posteromedial injection: a cadaveric study
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ORIGINAL ARTICLE • KNEE - ARTHROPLASTY
A comparative study comparing area of extension of posterior knee capsule via posteromedial injection: a cadaveric study Chatnarong Tubtim1 · Pat Laupattarakasem1 · Wiroon Laupattarakasem2 · Kowit Chaisiwamongkol3 Received: 13 September 2018 / Accepted: 9 February 2019 © Springer-Verlag France SAS, part of Springer Nature 2019
Abstract Background Periarticular multimodal drug injection (PMDI) has gained popularity as common postoperative pain protocols in knee arthroplasty. PMDI sites can vary, but posterior capsule (PC) is a common injection site because of its abundance of pain nociceptors. Purpose To prove the hypothesis whether posteromedial drug injection alone is sufficient to provide enough effect covering the PC in order to reduce risks of neurovascular injury. Secondary outcomes are to find proper volume of injection and safe zone for PMDI injection. Methods Ten fresh cadaveric knees were allocated into two equal groups, which differed in volume of dye injection: 25 ml and 50 ml. Dyes were injected into posteromedial capsule compartment, and the limbs were stored in a freezer for 2 weeks. Then the posterior compartment was carefully dissected to examine spreading of the dye solution. Results No dye staining was seen superficially beneath subcutaneous tissue of the knees. In deeper layer, the dye mostly occupied medially along the fascia covering semimembranosus muscles. However, dispersion was limited distally by intermuscular septa and popliteal vessels. The 50-ml injection group provided wider extension in the superficial layer, but not in the deep layer. Conclusion The intermuscular septa and the fascia of popliteal vessels were shown to be the boundary between posteromedial and posterolateral compartments of the knee. Separate PMDI for both compartments is necessary to occupy the entire PC. We suggest that 1.5 cm lateral to lateral border of PCL insertion, just above popliteus tendon, is the safe zone for injecting PMDI into the posterolateral capsule. Keywords Periarticular multimodal drug injection · PMDI · Total knee arthroplasty · Popliteal injury
Introduction Knee osteoarthritis is a common major problem that could deteriorate the patient’s functional status [1, 3, 6], and total knee arthroplasty (TKA) is a well-known procedure to resolve this problem by removing the eburnated cartilage and replacing with prosthetic implants [14]. This procedure would mitigate the knee pain and improve quality of life * Pat Laupattarakasem [email protected] 1
Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
2
Bangkok Hospital Khon Kaen, Bangkok Dusit Medical Services, Khon Kaen, Thailand
3
Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
[13]. Periarticular multimodal drug injection (PMDI) after TKA has gained popularity in recent years to alleviate postoperative pain [2, 11, 15, 18, 22]. In addition, PMDI also reduces requirements of epidural or parenteral postope
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