Abstract
BackgroundIn Total Knee Arthroplasty (TKA), residual pain may be secondary to soft tissue impingements, which are difficult to visualize around chromium-cobalt implants using medical imaging, so their interactions remain poorly understood. The goal of this work was to establish a protocol for in-vitro imaging of the soft tissues around TKA, usable during throughout the range of motion (ROM).MethodsThe full size range of a commercially available TKA prosthesis was manufactured by 3D-printing in non-magnetic and non-radiopaque polymer and implanted in 12 cadaveric knees. The relations between these implants and the soft tissues (Popliteus tendon, Medial and Lateral Collateral Ligament, Patellar and Quadriceps tendons) were analyzed, using MRI (5 embalmed specimens) and CT scans after injection of the tissues with barium-sulfate (3 embalmed and 4 fresh-frozen specimens).ResultsBoth MRI and CT scans enabled good identification of the soft tissues before TKA implantation. MRI produced minimal loss in signal and contrast, and neither the low temperature nor the embalming fluids compromised image quality. CT scans were more precise after TKA implantation, particularly the borders of the implant and the differentiation of soft tissues. Full ROM investigation, manual segmentation and three-dimensional reconstructions were possible only with the CT scan.ConclusionThe experimental approach described in this study was successful in visualizing the interactions between the soft tissue and the implants before and after TKA and during the full ROM. The coordinate system allows to localize precisely the different anatomic structures and to quantify any change due to prosthetic implantation.
Highlights
In Total Knee Arthroplasty (TKA), residual pain may be secondary to soft tissue impingements, which are difficult to visualize around chromium-cobalt implants using medical imaging, so their interactions remain poorly understood
In Total Knee Arthroplasty (TKA), residual pain and poor functional outcomes can be due to impingements between prosthetic components and soft tissues such as the Popliteus tendon (Barnes & Scott 1995; Kazakin et al 2014), the Patellar tendon (PT) (Argenson et al 2005), the iliotibial band (ITB) (Luyckx et al 2010) or the Medial Collateral Ligament (MCL) (Bonnin et al 2015; Bonnin et al 2013)
The investigation focused on the Popliteus Tendon, the Lateral Collateral Ligament (LCL), the Medial Collateral Ligament (MCL), the Quadriceps Tendon (QT) and the Patellar tendon (PT)
Summary
In Total Knee Arthroplasty (TKA), residual pain may be secondary to soft tissue impingements, which are difficult to visualize around chromium-cobalt implants using medical imaging, so their interactions remain poorly understood. In Total Knee Arthroplasty (TKA), residual pain and poor functional outcomes can be due to impingements between prosthetic components and soft tissues such as the Popliteus tendon (popliteus) (Barnes & Scott 1995; Kazakin et al 2014), the Patellar tendon (PT) (Argenson et al 2005), the iliotibial band (ITB) (Luyckx et al 2010) or the Medial Collateral Ligament (MCL) (Bonnin et al 2015; Bonnin et al 2013). Even when using metal artifact reduction sequences (M.A.R.S.), soft tissue visualization around TKA remains of poor quality
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