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Polydioxanone Biodegradable Pins in the Knee

MR Imaging

Claude B. Sirlin1, Robert D. Boutin2, Joachim Brossmann3, Mini N. Pathria1, F. Richard Convery4, William Bugbee4 and Donald Resnick5

1 Department of Radiology, UCSD Medical Center, 200 W. Arbor Dr., San Diego, CA 92103.
2 National Orthopedic Imaging Associates, San Mateo Imaging, 715 N. San Mateo Dr., San Mateo, CA 94401.
3 Klinik Fur Radiologische Diagnostik, Christians-Albrects Universitat, Arnold Heller Str. 9, 24105 Kiel, Germany.
4 Department of Orthopedics, UCSD Medical Center, San Diego, CA 92103.
5 Department of Radiology, Mail Code 9114, San Diego VA Medical Center, 3500 La Jolla Village Dr., San Diego, CA 92161.



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  		Fig. 1A. —30-year-old man with osteochondral defect of knee. Initial intraoperative photograph reveals large osteochondral defect (arrows) of medial femoral condyle.

 


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  		Fig. 1B. —30-year-old man with osteochondral defect of knee. Subsequent intraoperative photograph shows that after defect is excised and margins squared off, identical osteochondral shell with 5- to 6-mm-thick osseous portion (from donor knee) is placed into defect (arrows) and secured using polydioxanone pins (arrowheads).

 


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  		Fig. 2A. —45-year-old man with patellar and trochlear allografts. Axial T1-weighted spin-echo MR image (TR/TE, 600/15) obtained 6 months after surgery shows pins securing trochlear graft (4 pins, straight arrows and arrowheads) and patellar graft (1 pin, curved arrow), which are seen as ill-defined, 1- to 2-mm-thick lines of low signal intensity. One trochlear pin (straight arrows) is seen along its entire length; only portions of other three trochlear pins (arrowheads) can be seen.

 


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  		Fig. 2B. —45-year-old man with patellar and trochlear allografts. Axial T1-weighted spin-echo MR image (600/15) obtained 12 months after surgery shows that three pins (1 patellar pin and 2 trochlear pins) are no longer visible, presumably having been resorbed and replaced with bone. Two trochlear pins (arrowheads) have partially resorbed and are thinner than on A.

 


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  		Fig. 3A. —36-year-old woman with patellar allograft. Axial T2-weighted fast spin-echo MR image (TR/TE, 3000/63) with fat saturation obtained 3 months after surgery shows pin channels (arrows) of low signal intensity surrounded by small amount of edema. There is moderate effusion.

 


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  		Fig. 3B. —36-year-old woman with patellar allograft. Axial T2-weighted fast spin-echo MR image (3000/63) with fat saturation obtained 6 months after surgery shows that medical pin channel is now of high signal intensity (curved arrow). Lateral pin channel still shows some low signal intensity (straight arrow). Edema has diminished, and the size of the effusion is smaller.

 


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  		Fig. 4. —43-year-old man with patellar allograft. Axial T1-weighted spin-echo MR image (TR/TE, 600/15) obtained 12 months after surgery shows pin channel (arrows) with mean diameter of 4 mm. In general, patellar pin channels were thicker than nonpatellar pin channels.

 


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  		Fig. 5A. —43-year-old man with medial femoral condylar allograft. Sagittal T2-weighted fast spinecho MR image (TR/TE, 3000/63) with fat saturation obtained 3 months after surgery shows pin channel surrounded along entire length by rim of edema (arrows).

 


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  		Fig. 5B. —43-year-old man with medial femoral condylar allograft. Sagittal T2-weighted fast spin-echo MR image (3000/63) with fat saturation obtained 6 months after surgery shows that pin-related edema has resolved; pin channel now is evident as sharply defined line of high signal intensity (straight arrow). Because of slight sampling differences, second pin channel is also seen (arrowhead) on this image. Mild edema (curved arrow) has developed in response to allograft.

 


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  		Fig. 6. —29-year-old man with lateral femoral condylar allograft. Sagittal three-dimensional spoiled gradient-recalled fat-saturated image (TR/TE, 47/7;flip angle, 60°) obtained 6 months after surgery shows focal 1- to 2-mm full-thickness articular cartilage defects at insertion sites of two pins (arrows). Small junctional defects at anterior and posterior margins of allograft are also seen (arrowheads). In general, cartilage defects were more common during the early postoperative period, and they usually resolved in patients examined serially.

 

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