A new injection method for identifying the subpopliteal recess of the knee

Yoko Tabira; Akihiro Yamashita; Keishiro Kikuchi; Aya Han; Keigo Shimizu; Tatsuya Harano; Yuto Haikata; Eiko Inoue; Kunimitsu Nooma; Joe Iwanaga; Tsuyoshi Saga; Koichi Watanabe

doi:10.1002/ca.24144

A new injection method for identifying the subpopliteal recess of the knee

Clin Anat. 2024 Feb 28. doi: 10.1002/ca.24144. Online ahead of print.

Authors

Yoko Tabira¹, Akihiro Yamashita^{2

3}, Keishiro Kikuchi^{1

2

3}, Aya Han¹, Keigo Shimizu³, Tatsuya Harano³, Yuto Haikata^{3

4}, Eiko Inoue³, Kunimitsu Nooma³, Joe Iwanaga^{1

5

6}, Tsuyoshi Saga⁷, Koichi Watanabe¹

Affiliations

¹ Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Fukuoka, Japan.
² Department of Orthopedic Surgery, Kurume University School of Medicine, Fukuoka, Japan.
³ Graduate School of medicine, Kurume University School of Medicine, Fukuoka, Japan.
⁴ Dental and Oral Medical Center, Kurume University School of Medicine, Fukuoka, Japan.
⁵ Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.
⁶ Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
⁷ Domain of Anatomy, Kurume University School of Nursing, Fukuoka, Japan.

PMID: 38419377
DOI: 10.1002/ca.24144

Abstract

The posterolateral region of the knee has a complex and diverse anatomy. Hydrarthrosis of the knee can potentially communicate with other parts of the joint space. The joint fluid distribution reflects anatomical communications between synovial spaces. To observe the continuity between the knee joint cavity and the surrounding bursa, we devised a dissection method with a new injection agent, an eosin-containing congealed liquid that spreads uniformly over the entire space. The purpose of this study was to perform a detailed examination of the subpopliteal recess (SPR) where a bursa connects to the knee joint capsule. We also reported the advantages of this new injection agent compared with conventional materials (latex and epoxy resin). Twenty-two formalin-fixed cadavers (34 knees), two N-vinyl-pyrrolidone (NVP)-fixed cadavers (4 knees), and two cadavers (3 knees) fixed by Thiel's method were used. After filling the knee joint space and SPR with eosin congealed liquid, the specimens were dissected to investigate the morphology of the SPR. In addition, three different types of injection agents were assessed. The SPR extended distally along the popliteus tendon. The SPR length was 22.64 ± 11.38 mm from the upper end of the lateral tibial condyle to the lower end of the depression. The existence of a fabellofibular ligament made the SPR significantly longer, but abrasion of the femoral articular cartilage did not affect the SPR. Furthermore, the relationship between the popliteus muscle and the SPR was classified into three types (types 1-3). Types 2 and 3 in which the SPR extended to the proximal tibiofibular joint may cause instability of the knee joint. The eosin congealed liquid was highly useful in many aspects, such as fluidity and injection workability. The new dissection method with eosin congealed liquid provides insights into the anatomy of the posterior lateral knee, which are useful for radiological diagnoses and clinical treatments.

Keywords: N-vinyl-pyrrolidone (NVP)-fixed method; Thiel's method; anatomy; bursa; eosin-containing congealed liquid; fabellofibular ligament; hydrarthrosis; joint capsule; knee joint; popliteus tendon; synovial.