The Popliteal Artery is Safe in Medial Meniscal Repair Using All Inside Devices in Adults: An MRI-Based Simulation Study

C Muhammed Shamseer; N Nizaj; Appu Benny Thomas; Julio Chacko Kandathil; Bipin Theruvil

doi:10.1007/s43465-022-00755-9

The Popliteal Artery is Safe in Medial Meniscal Repair Using All Inside Devices in Adults: An MRI-Based Simulation Study

Indian J Orthop. 2022 Sep 22;56(12):2077-2085. doi: 10.1007/s43465-022-00755-9. eCollection 2022 Dec.

Authors

C Muhammed Shamseer¹, N Nizaj¹, Appu Benny Thomas¹, Julio Chacko Kandathil², Bipin Theruvil^{1

3}

Affiliations

¹ Department of Orthopedics, VPS Lakeshore Hospital, Kochi, India.
² Department of Radiology, VPS Lakeshore Hospital, Kochi, India.
³ Present Address: Arthroplasty and Sports Medicine, Medical Trust Hospital, Ernakulam, India.

Abstract

Introduction: This simulation study on MRI of the knee was performed to assess the risk of injury to the popliteal artery (PA) and common peroneal nerve (CPN) during all-inside meniscal repairs in adults.

Methods: We simulated repair of the posterior horn of both medial (PHMM) and lateral menisci (PHLM) through anteromedial (AM) and anterolateral (AL) portals, using straight and curved devices, on 200 magnetic resonance imaging (MRI) scans taken with the knee in extension. For simulation using straight devices, the shortest distance from the menisco-capsular junction (MCJ) and the free edge of the meniscus to PA and CPN in vectors of AM and AL portals was measured. In curved devices, the closest extracapsular distance from the device tip to PA was measured.

Results: With a straight device through AM portal, the mean distance from the MCJ of PHMM to the PA was 20.7 ± 3.15 mm (13.5-27.4). In PHMM repair through AM portal using a curved device, the mean extracapsular distance from the device tip to PA was 18.8 ± 4 mm (7.7-27.2) while pointing toward and 26 ± 4.5 mm (15.5-35.6) while pointing away from the midline. When using straight devices, the average distance from free edge of LM to PA was 18.5 ± 3.3 mm (9.6-31.2) and from MCJ to PA was 8.9 ± 2.4 mm (3.5-18.8). The average distance measured from the MCJ to CPN through AM and AL portals using straight devices was 19.4 ± 2.8 mm (10.2-32.5) and 22 ± 2.8 mm (10.4-36.7) respectively.

Conclusion: In adults, PA is safe in PHMM repairs using both straight and curved devices irrespective of depth and direction of insertion. In PHLM repairs, the PA is at risk with both straight and curved devices. We recommend adjusting the depth of insertion to as minimum as possible to just penetrate the capsule. The CPN is safe in LM repairs using all-inside devices.

Level of evidence: Level IV.

Keywords: All inside; Arthroscopic meniscal repair; Common peroneal nerve; Knee arthroscopy; MRI; Neurovascular injury; Popliteal artery; Simulation.

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