Dynamic evaluation of the infrapatellar fat pad after anterior cruciate ligament reconstruction using ultrasonography

Takashi Kitagawa, Junsuke Nakase, Hitoaki Numata, Takeshi Oshima, Yasushi Takata, Hiroyuki Tsuchiya
2016 Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology  
Anterior knee pain is one of the common complications that arises after anterior cruciate ligament reconstruction (ACLR). Anterior knee pain after ACLR may be caused by abnormalities in certain structures, such as the patellar tendon and the infrapatellar fat pad (IPFP). As the infrapatellar plica supports the IPFP, the shape and dynamics of the IPFP might change after ACLR, but few studies have investigated these changes objectively. In the present study, we aimed to compare the dynamics of
more » ... IPFP in a reconstructed knee with those in the contralateral knee by examining the knee joints of patients who underwent ACLR using hamstring autografts. Material and method: Twenty-six patients provided informed consent to evaluate 52 knees by ultrasound. Inclusion criteria were as follows: anatomic single-bundle reconstruction with hamstring tendon grafts, and a knee flexion range of motion of 90 to 10 . Exclusion criteria were as follows: previous ligament reconstruction, and bilateral ACL injuries. Of the 26 patients, 20 (average age 26.6 ± 11.2 years; 7 male and 13 female; average post-operative period of 15.3 ± 6.6 weeks) were examined by an experienced physiotherapist at a knee flexion of 90 and 10 in the sitting position. Longitudinal ultrasonographic images of the anterior part of the knees were taken at the center of the patellar tendon, along the tendon fiber, in order to capture the IPFP and the patellar apex. The IPFP in the images were divided into superficial and deep parts. The superficial part of the IPFP was defined as a low echo intensity area of the upper layer of IPFP, and the thickness was measured 10 mm away from the patellar apex. The thickness was measured by using Image J. Differences between unaffected and affected knees were examined. Results: At a knee flexion of 90 , we found a significant difference in the mean thickness of the superficial area of the IPFP between unaffected (11.4 ± 4.2 mm) and affected (9.2 ± 3.0 mm) knees (p ¼ 0.01), as well as in the thickness change ratio of the superficial area of the IPFP before and after surgery between unaffected (278 ± 119%) and affected (178 ± 94%) knees (p < 0.01). We did not find a significant difference in the mean thickness of the superficial part of the IPFP between unaffected (4.8 ± 2.5 mm) and affected (5.9 ± 2.4 mm) knees (p ¼ 0.08) at a flexion of 10 . Discussion: The thickness at a knee flexion of 90 and thickness change ratio of the superficial part of the IPFP decreased after ACLR. The superficial part of the IPFP denotes the area of the IPFP above the vertical cleft and separates the IPFP into the central body and the superior tag areas. When the IPFP is resected during an operation, adhesions across the IPFP develop, decreasing mobility of the IPFP. Dysfunction of the IPFP may subsequently cause complications. Further studies are needed in order to determine the relationship between the IPFP and knee function. Conclusion: The thickness at a knee flexion of 90 and thickness change ratio of the IPFP decreased after ACLR. http://dx.Background: Posterior medial meniscus root tears cause a loss of hoop tension and eventually lead to osteoarthritis in the medial compartment of the knee joint. An acute root tear usually locates in the vascular zone, and because of its location, it has a high chance to heal after appropriate repair. There are many articles which were introduced a variety of repair. Therefore, the purpose of this article was to evaluate the clinical and radiologic results of arthroscopic pullout suture repair with a retrograde reaming device and a modified Mason-Allen stitch in the medial meniscus root tear. Material: 24 consecutive patients (24 knees) with a minimum of 1 years' follow-up were chosen to be analyzed after the treatment of arthroscopic pullout suture repair. Method: Final clinical outcomes were determined using a Lysholm scores, International Knee Documentation Committee (IKDC) scores, and Hospital for Special Surgery (HSS). In addition, Radiological evaluation was performed using magnetic resonance imaging (MRI), 3D computed tomography (CT) and the Kellgren-Lawrence grading system. Results: The preoperative mean Lysholm score was 57.1 ± 6.3, and the mean IKDC score was 40.3 ± 5.2. At last follow-up, the mean Lysholm score was 87.1 ± 6.9, and the mean IKDC score was 70.4 ± 2.5. Both the Lysholm score and IKDC score were significantly improved (p<0.001). And the mean HSS score increased from 68.3 ± 3.1 preoperatively to 89.2 ± 5.6 at final follow-up (p<0.001). According to the radiographic grades described by Kellgren and Lawrence, a radiographic evaluation at final follow-up showed an increase in radiographic grade by 1 grade in only 1 knee. Follow-up MRI was performed in 10 patients. Five patients showed complete healing and four patients showed partial healing, and 1 showed no healing with cleft of high signal or a ghost sign of preoperatively meniscus. And postoperatively mean extrusion of the midbody of the medial meniscus decrease 0.2 ± 0.4mm. Tibial tunnel
doi:10.1016/j.asmart.2016.07.109 fatcat:tqez67vyybe2vksqmne367fmky