Anatomical Safety Area for Periarticular Analgesic Infiltration through the Posterior Capsule in Total Knee Arthroplasty: Radiological Study in Magnetic Resonance
<b>Background</b>: One of the main challenges of orthopedic surgery is adequate pain management after total knee arthroplasty. This work aimed to determine the anatomical safety area for infiltration through the posterior capsule of the knee in prosthetic surgery using Magnetic Resonance...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/7/2123 |
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| author | Marta Mifsut-Aleixandre Damián Mifsut Eva María González-Soler Arantxa Blasco-Serra Alfonso Amador Valverde |
| author_facet | Marta Mifsut-Aleixandre Damián Mifsut Eva María González-Soler Arantxa Blasco-Serra Alfonso Amador Valverde |
| author_sort | Marta Mifsut-Aleixandre |
| collection | DOAJ |
| description | <b>Background</b>: One of the main challenges of orthopedic surgery is adequate pain management after total knee arthroplasty. This work aimed to determine the anatomical safety area for infiltration through the posterior capsule of the knee in prosthetic surgery using Magnetic Resonance Imaging (MRI). <b>Methods</b>: A descriptive, observational, cross-sectional study was performed on 126 knee MRIs. The variables studied were age, sex, and distance between different neurovascular structures of the popliteal fossa (tibial nerve, common peroneal nerve, and vascular bundle). Data were analyzed for normality (Kolmogorov–Smirnov) and variance homogeneity (Levène). A value of <i>p</i> < 0.05 and a confidence interval of 9% were considered statistically significant for all comparisons. Student’s <i>t</i>-test was used to compare the means between independent samples. <b>Results</b>: We observed statistically significant differences between the sexes regarding EP–EPS (external plateau–external popliteal sciatic nerve (common peroneal)), EP–IPS (external plateau–internal popliteal sciatic nerve (tibial)), and IP–PA (internal plateau–popliteal artery) measurements. The average distance between both nerves, EPS–IPS (external popliteal sciatic nerve and internal popliteal sciatic nerve), was 25.96 mm in females, while the value obtained in males was 29.93 mm, but this difference was not statistically significant. <b>Conclusions</b>: The average distance from the posterior capsule to the EPS and IPS nerves is greater in males than in females, despite no statistical differences. The presence of a lateralized arteriovenous bundle reduces the infiltration area of the external compartment. Regarding the safety area, infiltration of the internal compartment is safe since the volume diffuses into the muscle mass of the internal gastrocnemius upon injection. To infiltrate the external compartment, the needle must move at least 2 cm from the midline toward the external side (to exceed the maximum displacement of the neurovascular bundle established at 1.82 cm), and not advance beyond 0.76 cm (minimum distance at which we located the common peroneal nerve in the external compartment). |
| first_indexed | 2024-04-24T10:41:04Z |
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| id | doaj.art-4a259ada2c0c4d938138f4985f867e04 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-04-24T10:41:04Z |
| publishDate | 2024-04-01 |
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| spelling | doaj.art-4a259ada2c0c4d938138f4985f867e042024-04-12T13:21:36ZengMDPI AGJournal of Clinical Medicine2077-03832024-04-01137212310.3390/jcm13072123Anatomical Safety Area for Periarticular Analgesic Infiltration through the Posterior Capsule in Total Knee Arthroplasty: Radiological Study in Magnetic ResonanceMarta Mifsut-Aleixandre0Damián Mifsut1Eva María González-Soler2Arantxa Blasco-Serra3Alfonso Amador Valverde4Anatomy Department, Universitat de Valencia, 15 Av. Blasco Ibáñez, 46010 Valencia, SpainAnatomy Department, Universitat de Valencia, 15 Av. Blasco Ibáñez, 46010 Valencia, SpainAnatomy Department, Universitat de Valencia, 15 Av. Blasco Ibáñez, 46010 Valencia, SpainAnatomy Department, Universitat de Valencia, 15 Av. Blasco Ibáñez, 46010 Valencia, SpainAnatomy Department, Universitat de Valencia, 15 Av. Blasco Ibáñez, 46010 Valencia, Spain<b>Background</b>: One of the main challenges of orthopedic surgery is adequate pain management after total knee arthroplasty. This work aimed to determine the anatomical safety area for infiltration through the posterior capsule of the knee in prosthetic surgery using Magnetic Resonance Imaging (MRI). <b>Methods</b>: A descriptive, observational, cross-sectional study was performed on 126 knee MRIs. The variables studied were age, sex, and distance between different neurovascular structures of the popliteal fossa (tibial nerve, common peroneal nerve, and vascular bundle). Data were analyzed for normality (Kolmogorov–Smirnov) and variance homogeneity (Levène). A value of <i>p</i> < 0.05 and a confidence interval of 9% were considered statistically significant for all comparisons. Student’s <i>t</i>-test was used to compare the means between independent samples. <b>Results</b>: We observed statistically significant differences between the sexes regarding EP–EPS (external plateau–external popliteal sciatic nerve (common peroneal)), EP–IPS (external plateau–internal popliteal sciatic nerve (tibial)), and IP–PA (internal plateau–popliteal artery) measurements. The average distance between both nerves, EPS–IPS (external popliteal sciatic nerve and internal popliteal sciatic nerve), was 25.96 mm in females, while the value obtained in males was 29.93 mm, but this difference was not statistically significant. <b>Conclusions</b>: The average distance from the posterior capsule to the EPS and IPS nerves is greater in males than in females, despite no statistical differences. The presence of a lateralized arteriovenous bundle reduces the infiltration area of the external compartment. Regarding the safety area, infiltration of the internal compartment is safe since the volume diffuses into the muscle mass of the internal gastrocnemius upon injection. To infiltrate the external compartment, the needle must move at least 2 cm from the midline toward the external side (to exceed the maximum displacement of the neurovascular bundle established at 1.82 cm), and not advance beyond 0.76 cm (minimum distance at which we located the common peroneal nerve in the external compartment).https://www.mdpi.com/2077-0383/13/7/2123periarticular analgesic infiltrationradiological studyanatomical safety areaknee prosthesismagnetic resonance anatomy |
| spellingShingle | Marta Mifsut-Aleixandre Damián Mifsut Eva María González-Soler Arantxa Blasco-Serra Alfonso Amador Valverde Anatomical Safety Area for Periarticular Analgesic Infiltration through the Posterior Capsule in Total Knee Arthroplasty: Radiological Study in Magnetic Resonance Journal of Clinical Medicine periarticular analgesic infiltration radiological study anatomical safety area knee prosthesis magnetic resonance anatomy |
| title | Anatomical Safety Area for Periarticular Analgesic Infiltration through the Posterior Capsule in Total Knee Arthroplasty: Radiological Study in Magnetic Resonance |
| title_full | Anatomical Safety Area for Periarticular Analgesic Infiltration through the Posterior Capsule in Total Knee Arthroplasty: Radiological Study in Magnetic Resonance |
| title_fullStr | Anatomical Safety Area for Periarticular Analgesic Infiltration through the Posterior Capsule in Total Knee Arthroplasty: Radiological Study in Magnetic Resonance |
| title_full_unstemmed | Anatomical Safety Area for Periarticular Analgesic Infiltration through the Posterior Capsule in Total Knee Arthroplasty: Radiological Study in Magnetic Resonance |
| title_short | Anatomical Safety Area for Periarticular Analgesic Infiltration through the Posterior Capsule in Total Knee Arthroplasty: Radiological Study in Magnetic Resonance |
| title_sort | anatomical safety area for periarticular analgesic infiltration through the posterior capsule in total knee arthroplasty radiological study in magnetic resonance |
| topic | periarticular analgesic infiltration radiological study anatomical safety area knee prosthesis magnetic resonance anatomy |
| url | https://www.mdpi.com/2077-0383/13/7/2123 |
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