knee postoperative lecture dubai

7/26/2019 Knee Postoperative Lecture Dubai

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The Knee Joint: MRI ofthe Intra and Extra-

ArticularPostop. Derangements

Claude Pierre-Jerome M.D.PhDEmor! "ni#ersit! $chool of Medicine

Department of Radiolog!Atlanta. %A


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The Postoperative

KneeIntroduction

Di&erent approach to MR images ofthe operated 'nee due to the:

#ariet! of structural changes

inside the (oint and outside the (oint.


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MRI - IndicationsFindings: Post op Changes in the:

). Hyaline Cartilage

*. Meniscus

+. Ligaents

,. Tunnels !Feur "Ti#ia$. %one Marro&

. Ho'a(s Fat


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)* Hyaline CartilageProperties o+ the Knee

Cartilage: Pro#ides sooth, lo&-+riction

surface for proper (oint function #sorption o+ +orces across the

(oint /igh 0ear Resistance

Poor Re eneration


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Hyaline Cartilage Is an vasculartissue

A1undant extracellular Matrix richin Type II collagen and

Proteogl!can

2eixeira CC. 2he Angle 3rthodontist: Jan*4456ol.77.n4.)pp.)*8-)+,


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Cartilage - Imaging

Protocol2$E 2) sagittal

0ater-sensiti#e se9uence $agittal

Coronal

%RE in-out phase se9uence +-D; PD $PAIR Axial


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.oral Cartilagearro


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Cartilage /aage

failure;Causes o+ Cartilage Failure: Traua 0steoarthritis Chondroc!te Protein $!nthesis

Inhi1ition Chondroc!te Apoptosis cellular

death;

=asper J et al. "$ Musculo$'eletal Re#ie


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Cartilage/e+ect

PostTrauatic


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Incidence of Cartilage

>esionsFre1uencyof lesions increases: In thletes Cartilage >esions ma! occur

&ith:

Med*Meniscus tear

CL tear unhappytriad

MCL tear

=as er et al. "$ Musculo$'eletal Re#ie<


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0steo rthritis


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Incidence of Cartilage

>esions 7? of people older than 7 !ears

ha#e osteoarthritis !0$ Pre#alence of 3AIncreases


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Cartilage Repair2urgical Procedures: ). Marrow Stimulation

microfracturing a1rasion drilling

*. 3steochondral Transplantation

+.utologous Chondroc!teImplantation

=asper J et al. "$ Musculo$'eletal Re#ie


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3steochondral

2ransplantation3oal: Resurfacing cartilage defect


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3steochondral

2ransplantation llogra+t from cada#er; used for:

Large 0steochondralde+ects

2rauma....3steochondritis Dissecans

A#ascular @ecrosis

Implantation should 1e performed


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3steochondral

2ransplantation utogra+tfrom the patient;

"sed to repair small cartilage

defects lesions *.7 to ) mm indiameter;

/ar#est osteochondral plugs from a

non


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0steochondralTransplantatio

nCartilage Repair

in the lateral

femur cond!le

Congruent graft


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2ae Patient

26 T)7 2agittal

Cartilage repair

in the lateral

+eur chondyle

!arro&$


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$ame patient

8 years later

Congruent

Cartilage

$urface arro


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$ame patient3R6 sagittal


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Cartilage Repair2urgical Procedures: ).Marro< $timulation

microfracturing a1rasion drilling

*. 3steochondral 2ransplantation

9* utologous ChondrocyteIplantation


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Cartilage Repairutologous Chondrocyte

Iplantation!CI$

"sed for oderate to largecartilage defects o#er *- cm;

Measurements of the defect in +planes


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utologous Chondrocyte

Iplantation Techni1ue:

/ar#est chondrocytesfrom

trochlea

%ro< them in culture

appro* )4illion

Reiplantthem into chondraldefect

covered #y periosteal ;ap


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/iagra o+ utologous ChondrocyteTransplantation

Peterson >. Am J $ports Med5+4*44*;#ol));pp*-)*


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Iplantation

Remodeling and Maturation)+


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Iplantation

+ !.o. patient


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$ame patient@ormal

signal

intensit!

of the

cartilage!arro&$

3R6 T)7 Fat 2at Cor


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$ame patient

3R6 2agittal


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3R6 T)7 Fat 2at

$ame patient


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Iplantation

MRI assessent:

2ignalsof the cartilageB/omogeneous

Marro& 6deaB.ad(acent 1one

Fluid 1et


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Iplantation

Coplications: 3ccur &ithin the =rst 4 years

Postop. Ad#erse Prognostic Factors are:

Age

Duration of $!mptoms

@os. of Prior $urgicalProcedures


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Iplantation

Postsurgical Coplications: Cartilage Hypertrophy

3ra+t /elaination

Intraarticular dhesions


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Iplantation,+ !.o. patient


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$ame patient

/!pertroph!

of the

transplant

arro


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+ !ears later

after

second operation

%raft

Delamination

arro


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$ame patient

%raft

delaminationarro


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4* The MeniscusThe roles o+ eniscus are: 2i1iofemoral load transmission

+4-? in standing position $ta1ilisationof the (oint $hoc' a1sorption >u1rication 7,? of meniscal


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Meniscus GImaging

Protocol2$E PD $agittal

Hat.$at. se9uence $agittal

Coronal

PD $PAIR Axial


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The .oral MeniscusMR ppearance:

Lo&signal

2harp #orders

Triangular in cross section

.oral Lateral


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.oral LateralMeniscus


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Meniscal Tear


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Meniscal 2urgery0#>ectives:2o preser#e as much meniscal

function as possi1le

2o pre#ent degenerati#e changes

of the 'nee


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Meniscal 2urgery

Partial Meniscectoy Arthroscopic Meniscal Repair &ith

2uturing Meniscal llogra+ts Total Meniscectomy

Rath E. Fr J $ports Med *4445+,:**-*7


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0perated MeniscusMR ppearance: Meniscus truncatedsmall

1lunted 1od!; Irregular arginsof the

meniscal remnant #noral signal intensit! in

meniscal remnant


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PartialMeniscecto

y

Partial

meniscecto

m!of the

Med.meniscus

anterior horn

arro


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$amepatien

t

3R6 7ater

6citation2agittal

T t l


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TotalMeniscecto

y2otal Resection

of the

Medial Meniscus

Anterior /orn

3A changes arro


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2aepatient

26 T47 Fatsat2agittal


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Retorn MeniscusMR appearance o+ Recurrent

Tear:

Joint uid extending into a cleft


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RecurrentTear

Re-tear

of the

Medialmeniscus

posteriorhorn

arro


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$amepatient

3R6

7ater

6citation

2agittal


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9* CL

Reconstruction CLis the most commonl!

reconstructed ligament in the 'nee

Common 2urgical Methods are: ). Patellar Tendon utogra+t

1one-patellar tendon-1one;

*. Hastring utogra+t


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MRI o+ the 3ra+tMRI is use+ul in: E#aluating the Integrityo+ the

3ra+t Detecting Coplications; $ho


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MR imaging protocol). %RE 2*0BBBBBBB2rans#ersal

*. %RE 0ater excitationB$agittal

+. %RE in-out phaseBBB$agittal

,. H$E 2*0 fat satBBB..$agittal

. H$E 2)0BBBBBBB..Coronal


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MRI o+ the 3ra+tThe .oral 3ra+t ppearance:

$hort Echo Images 2)0 K 2*0;:

Lo& 2ignal Intensit!


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MRI o+ the 3ra+tLong 6cho Iages 2*0;:

Intermediate signal


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CL 3ra+t@ormal

AC> graft

arro


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Coplications

3ra+t Misplaceent

Hemur anterior;

2i1ia posterior;

causes Insta#ility

2i1ia anterior; or Hemur posterior;

causes Ipingeent


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@ertical3ra+t

@ertical 3ra+t*

*8 !ears old female


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Coplications

%raft Tears partialKcomplete;

%raft Ipingeentfromosteoph!tes scre


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3ra+t Tear

%raft 2ear. *7!ears old !ear

male


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3ra+t Tear

, !.o pt.


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Ipingeent

%raft

Impingement

1!

3steoph!tes

arro


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Ipingeent

3ra+tIpingeent!arro&$

+7 !ears old male


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MRI o+ the Tunnel

Feoral tunnel: Coronal Plan

)) o(clocA rightAnee

) o(clocA le+t Anee

Right:)) o(clocA >eft: )


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Right:)) o clocA >eft: )o(clocA


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MRI of the tunnel

Ti#ial tunnel:

$agittal plan

parallel to the slope of intercond!larroof

Right- B o(clocA

Le+t- o(clocA


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Ti#ial tunnel

2he

%luensaat(sLine

Le+t Knee

Ti#ial


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Ti#ialtunnel

2he%luensaatLine

@ormal 2i1ia2unnel

C li ti f th


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Complications of thetunnel

6nlargeentof the tunnel

Cysticchange ad(acent to thetunnel


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Ti#ialtunnel

Enlargement ofthe ti1ial tunneland c!stic

change arro


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Ti#ialtunnel

Enlargement ofthe ti1ial tunnelarro


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Coplications

Anterior rthro=#rosis

Cyclop;


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rthro=#rosis

Area of lo&signal on allse1uences

0ell dened round =#roticlesionGLC!clopsL

nterior to the gra+ton sagittalimages

h


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rthro=#rosis

** !.o.pt.


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Arthro1rosis c!clopL


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Coplications

Hard&are +ailure:

1one plug dislodgement

screw displacement


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Ipingent

Dislodgement of thescre

knee postoperative lecture dubai

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