Sonographic and radiographic evaluation of the extensor tendons in early postoperative period after total knee arthroplasty

• Published in: Skeletal radiology Vol. 50; no. 3; pp. 485 - 494
• Main Authors: Creteur, Viviane, De Angelis, Riccardo, Absil, Julie, Kyriakidis, Theofylaktos, MADANI, Afarine
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2021; Springer; Springer Nature B.V
• Subjects: Arthroplasty (knee); Effusion; Evaluation; Imaging; Joint replacement surgery; Joint surgery; Joints (anatomy); Knee; Mechanical properties; Medicine; Medicine & Public Health; Modulus of elasticity; Nuclear Medicine; Orthopedics; Pathology; Postoperative period; Quadriceps muscle; Radiographs; Radiography; Radiology; Scientific Article; Shear; Stiffness; Surgery; Surgical implants; Synovitis; Tendons; Thickening; Ultrasonic imaging; Ultrasonic testing; Ultrasound; Total knee arthroplasty; Shear wave elastography; Patellar tendon; Postoperative evaluation; Radiographs; Quadriceps tendon; Ultrasound; Preoperative evaluation
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-020-03574-x

Objective To prospectively assess the early changes in the quadriceps and patellar tendons before and after total knee arthroplasty using ultrasound, shear wave elastography, and X-rays. Materials and methods Radiographs, ultrasound, and shear wave elastography were performed on 23 patients (16 women; aged 51–85, mean 66 ± 9 years) before and after surgery at 6 weeks and on 11 patients at 3 months. Patellar position and patellar tendon lengths were evaluated by radiography; joint effusion or synovitis, quadriceps and patellar tendon lengths, and thicknesses, echogenicity, vascularity, and stiffness were assessed with ultrasound and shear wave elastography. Results In the early postoperative period, 87% of the patients had joint effusion, and 43% had signs of synovitis. There was a significant thickening of the quadriceps tendon in 51.5% ( p  < .0001) and of the patellar tendon in 93.8% ( p  < .0001 ) of patients with a significant shortening of the patellar tendon in 7.8% ( p  < .0001). A hypoechoic defect on the medial aspect of the quadriceps tendon was found in 87% of the patients. There was a significant increase in Young’s modulus in the quadriceps tendon ( p  = .0006) but not in the patellar tendon. Conclusion The following should not be considered to be pathological findings at early postoperative imaging: joint effusion, synovitis, increasing of stiffness and thickening of quadriceps tendons by more than 50%, thickening of patellar tendon by more than 90%, focal defect through the medial aspect of the quadriceps tendon, and shortening of the patellar tendon by 8%.