Nerve lesions during arthroscopic procedure: a literature overview

Abstract

Arthroscopy is more and more popular. Although minimally-invasive, it's not completely free of complications as nerves lesions which can be invalidating for the patient and frustrating for the surgeon with significant economic, psychological and medico-legal implications. The purpose was to review the literature about nerve injuries related to arthroscopy. A scientific literature review was performed in PubMed/Medline, including articles dealing with cases of iatrogen lesions of the peripheral nerves occurred during arthroscopic procedures. These lesions are mainly due to direct damage by nerve section while cutting for making the portals or during surgical maneuvers, or indirect damage due to traction or pressure mechanisms especially for errors in patient positioning. Also the tourniquet can lead to compression and ischemic nerve injury. Arthroscopy can cause both transient and permanent neurological lesions manifested with dysesthesia up to paralysis according to Seddon's classification in neuroapraxia, axonotmesis and neurotmesis. Incidence of complications in general and of nerve injuries during arthroscopy are reported by joint. A rigorous respect for surgical technique and all perioperative precautions, particularly in relation to the positioning of the patient, greatly reduce the risk of nerve injury. The suggested waiting time before surgical nerve revision is 6 months. In the meanwhile the patient should perform physiotherapy constantly and improvements should be evaluated with clinical examination and electromyography 15-20 days after the lesion, and thereafter at 3 and 6 months.

Complete tibial nerve lesion secondary to postoperative popliteal pseudoaneurysm following anterior cruciate ligament arthroscopic reconstruction: A series of two patients

“…[ 4 , 5 , 22 ] Due to a growing demand for arthroscopic ACLR, the incidence of iatrogenic popliteal pseudoaneurysm has increased in recent years. [ 10 ] Hence, several recommendations, which are reviewed elsewhere,[ 1 , 7 ] have been proposed to prevent vessel violations.…”

Epidemiologie, Einteilung und Läsionsmuster von peripheren Nervenverletzungen

“…Iatrogene Dehnungsschäden entstehen vor allem bei der Lagerung für eine Operation, durch vermehrten Zug bei Arthroskopien oder Frakturrepositionen sowie beim Einsetzen von Wundretraktoren 9 . Die Inzidenz für postoperative Nervenschäden nach arthroskopischen Interventionen wird in der Literatur wie folgt angegeben: 1,7–2,5 Prozent für die Articulatio cubiti 18 und 1,17–1,5 Prozent für die Articulatio carpi 19 . Kutane sensible Nervenäste werden dabei durch die Trokarzugänge affektiert.…”