A comparative study comparing area of extension of posterior knee capsule via posteromedial injection: a cadaveric study

  • Chatnarong Tubtim
  • Pat LaupattarakasemEmail author
  • Wiroon Laupattarakasem
  • Kowit Chaisiwamongkol
Original Article • KNEE - ARTHROPLASTY



Periarticular multimodal drug injection (PMDI) has gained popularity as common postoperative pain protocols in knee arthroplasty. PMDI sites can vary, but posterior capsule (PC) is a common injection site because of its abundance of pain nociceptors.


To prove the hypothesis whether posteromedial drug injection alone is sufficient to provide enough effect covering the PC in order to reduce risks of neurovascular injury. Secondary outcomes are to find proper volume of injection and safe zone for PMDI injection.


Ten fresh cadaveric knees were allocated into two equal groups, which differed in volume of dye injection: 25 ml and 50 ml. Dyes were injected into posteromedial capsule compartment, and the limbs were stored in a freezer for 2 weeks. Then the posterior compartment was carefully dissected to examine spreading of the dye solution.


No dye staining was seen superficially beneath subcutaneous tissue of the knees. In deeper layer, the dye mostly occupied medially along the fascia covering semimembranosus muscles. However, dispersion was limited distally by intermuscular septa and popliteal vessels. The 50-ml injection group provided wider extension in the superficial layer, but not in the deep layer.


The intermuscular septa and the fascia of popliteal vessels were shown to be the boundary between posteromedial and posterolateral compartments of the knee. Separate PMDI for both compartments is necessary to occupy the entire PC. We suggest that 1.5 cm lateral to lateral border of PCL insertion, just above popliteus tendon, is the safe zone for injecting PMDI into the posterolateral capsule.


Periarticular multimodal drug injection PMDI Total knee arthroplasty Popliteal injury 


Compliance with ethical standards

Conflict of interest

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

Cadaveric experimental study had been approved by the Khon Kaen University Ethics Committee for Human Research.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopedics, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
  2. 2.Bangkok Hospital Khon KaenBangkok Dusit Medical ServicesKhon KaenThailand
  3. 3.Department of Anatomy, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand

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