Popliteal neurovascular bundle is safe during inside-out repair of medial meniscus without a safety incision

Gupta, Himanshu; Ghasi, Rohini Gupta; Kataria, Himanshu; Jain, Vaibhav; Shankar, Vikas; Daripa, Rakesh Kumar; Upadhyay, Ashish Datt

doi:10.1007/s00167-018-5060-x

Cited by 11 publications

(14 citation statements)

References 24 publications

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“…Cuellar et al reported that the risk of lateral meniscal repair is safer at 90° and worse with extension of the knee (Cuellar et al, 2015). Recently, an MRI based study demonstrated the significant risk to the neurovascular structures with repair of the lateral meniscus (Gupta et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Proximity of the neurovascular structures during all-inside lateral meniscal repair in children: a cadaveric study

et al. 2018

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PurposeMeniscal repair has become increasingly common in a pediatric and adolescent population. All-inside repair techniques are utilized more often given their ease of insertion and decreased operative time required. However, there are possible risks including damage to adjacent neurovascular structures. The purpose of this study to was examine the proximity of the neurovascular structures during lateral meniscus repairs in pediatric specimens simulating a worst-case scenario.MethodsTen pediatric cadaveric knees (age 4–11) were utilized and simulated lateral meniscal repair through the posterior horn of the lateral meniscus and both medial and lateral to the popliteal hiatus through the body of the lateral meniscus was performed with an all-inside meniscal repair device. The distance to the popliteal artery or peroneal nerve was measured.ResultsDuring posterior horn repair, the average distance from the all-inside device to the popliteal artery was 1.9 mm ± 1.1 mm. There was penetration of the artery in one specimen. During repair on the medial side of popliteal hiatus, the average distance from the all-inside device to the peroneal nerve was 3.2 mm ± 2.0 mm. During repair on the lateral side of popliteal hiatus, the average distance from the all-inside device to the peroneal nerve was 12.4 mm ± 3.7 mm.ConclusionsThis study demonstrates that the proximity of the neurovascular structures to the lateral meniscus in children is extremely close and at high risk during meniscal repair with all-inside devices. This study gives important data for the proximity of these structures during these repair techniques.Level of evidenceLevel 5 Cadaveric Study.

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Section: Discussionmentioning

confidence: 99%

Proximity of the neurovascular structures during all-inside lateral meniscal repair in children: a cadaveric study

et al. 2018

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“…An overarching concern when performing lateral meniscus repairs by either technique is the safety of the neurovascular structures in this area. Tears medial to the popliteus tendon are preferably repaired using an all-inside device since the popliteus neurovascular structures are not safe by using any portal or cannula type [45]. The all-inside device for posterior repairs must not be inserted from the anterolateral portal.…”

Section: Lateral Meniscus Longitudinal Tearsmentioning

confidence: 99%

Lateral Meniscus Tears in Acl Injured Knee

Tapasvi¹

2021

Hip Knee J.

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Anterior cruciate ligament (ACL) tears can be associated with injuries to the lateral meniscus (LM) in about 20-30% cases. The lateral meniscus is more mobile than the medial and besides contributing to load transmission, it also stabilizes the knee in pivot-shift testing. The LM tears more often in the acute setting and its incidence does not rise in cases of chronic ACL instability. Lateral meniscus tears can be minor or major depending how severely the knee function gets impaired. Major tears are the complete radial tears, longitudinal bucket handle tears and posterior root tears. Male gender, high body mass index and contact injury mechanism are all risk factors for an LM tear. Anatomic factors which can contribute to LM tears include a high posterior tibial slope, varus malalignment and greater asymmetry between medial and lateral slopes. The lateral meniscus must be saved and repaired whenever possible to prevent residual knee instability and progressive lateral compartment arthritis, which can set in soon after a meniscectomy. The development of techniques and technology have rendered most tears amenable to repair. Longitudinal tears can be repaired by the all-inside or inside-out technique and the needles and devices must be inserted through a high anteromedial or transpatellar portal to prevent injury to the popliteal neurovascular structures. A lateral safety incision must always be used for inside-out repairs. Radial tears can be repaired by two horizontal sutures, a cross stich, a cross-tag or a hash-tag suture configuration. Lateral meniscus posterior root repairs are repaired by transtibial technique, either by drilling an independent anatomic tunnel or the sutures pulled out via the ACL tibial tunnel. The lateral meniscus has high healing rates and repairs yield improvement in functional outcome, beside delaying radiographic arthritis.

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“…Nevertheless, meniscus repair has a certain degree of risk of neurovascular injuries, especially in cases with all-inside repair for a tear in the posterior horn of the lateral meniscus (LM). 8 , 9 Some cadaveric or magnetic resonance imaging (MRI) studies showed that repair of the posterior LM through an anterolateral portal increased the risk of popliteal artery injury, 10 , 11 , 12 , 13 , 14 and this was recognized as a relative contraindication. However, performing meniscus repair of the posterior LM from an anteromedial portal to avoid vascular injury requires that a suture device penetrate the meniscus obliquely.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Assisted Arthroscopic All-Inside Repair Technique for Posterior Lateral Meniscus Tear

Ozeki

Koga

Nakamura

et al. 2022

Arthroscopy Techniques

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Popliteal neurovascular bundle is safe during inside-out repair of medial meniscus without a safety incision

Abstract: III.

Cited by 11 publications

References 24 publications

Proximity of the neurovascular structures during all-inside lateral meniscal repair in children: a cadaveric study

Proximity of the neurovascular structures during all-inside lateral meniscal repair in children: a cadaveric study

Lateral Meniscus Tears in Acl Injured Knee

Ultrasound-Assisted Arthroscopic All-Inside Repair Technique for Posterior Lateral Meniscus Tear

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