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The Effect of Knee Flexion Angle on the Neurovascular Safety of All-Inside Lateral Meniscus Repair: A Cadaveric Study

      Purpose

      To evaluate if different knee flexion angles can modify the neurovascular injury risk during lateral meniscus repair.

      Methods

      Twenty cadaveric knees were studied. An all-inside suture device (FasT-Fix; Smith & Nephew, Andover, MA) was placed at the posterior horn and at the medial and lateral limits of the popliteal hiatus. The minimal distances between the device and the popliteal artery and peroneal nerve were measured with the knee at 90°, 45°, and 0° of flexion through a limited posterolateral arthrotomy.

      Results

      The distance between the device when inserted at the lateral edge of the popliteal hiatus and the peroneal nerve decreased from a median of 26 mm (interquartile range [IQR], 3.5 mm; range, 19 to 29 mm) at 90° to 21.5 mm (IQR, 4.5 mm; range, 14 to 25 mm) at 45° and 15.5 mm (IQR, 6.5 mm; range, 4 to 20 mm) at 0° (significant differences, P < .001). The distance between the device when inserted at the medial edge of the popliteal hiatus and the peroneal nerve decreased from 16 mm (IQR, 3.3 mm; range, 9 to 21 mm) at 90° to 12 mm (IQR, 4.3 mm; range, 9 to 16 mm) at 45° and 7 mm (IQR, 4.0; range, 4 to 15 mm) at 0° (significant differences, P < .001). The distance between the device when inserted at the medial edge of the popliteal hiatus and the popliteal artery decreased from 21 mm (IQR, 5.0 mm; range, 11 to 27 mm) at 90° to 19 mm (IQR, 5.0 mm; range, 10 to 23 mm) at 45° and 16 mm (IQR, 7.5 mm; range, 10 to 23 mm) at 0° (significant differences, P < .001). The distance between the device when inserted 5 mm lateral to the posterior root of the lateral meniscus and the popliteal artery decreased from 13 mm (IQR, 4.3 mm; range, 7 to 27 mm) at 90° to 10.5 mm (IQR, 4.3 mm; range, 4 to 19 mm) at 45° and 5.5 mm (IQR, 4.0 mm; range, 0 to 14 mm) at 0° (significant differences, P < .001).

      Conclusions

      The risk of injury to the popliteal artery or to the peroneal nerve during all-inside repair of the posterior half of the lateral meniscus is lower at 90° of flexion and increases with knee extension to 45° and 0°.

      Clinical Relevance

      All-inside meniscal repair of the lateral meniscus is safer with the knee at 90° of flexion.
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      References

        • Greis P.E.
        • Bardana D.D.
        • Holmstrom M.C.
        • Burks R.T.
        Meniscal injury: I. Basic science and evaluation.
        J Am Acad Orthop Surg. 2002; 10: 168-176
        • Furie E.
        • Yerys P.
        • Cutcliffe D.
        • Febre E.
        Risk factors for arthroscopic popliteal artery laceration.
        Arthroscopy. 1995; 11: 324-327
        • Kiss H.
        • Drekonja T.
        • Grethen C.
        • Dorn U.
        Postoperative aneurysm of the popliteal artery after arthroscopic meniscectomy.
        Arthroscopy. 2001; 17: 203-205
        • Barber F.A.
        • Stone R.G.
        Meniscal repair. An arthroscopic technique.
        J Bone Joint Surg Br. 1985; 67: 39-41
        • Kim Y.M.
        • Rhee K.J.
        • Lee J.K.
        • Hwang D.S.
        • Yang J.Y.
        • Kim S.J.
        Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn.
        Arthroscopy. 2006; 22: 795.e1-795.e4
        • Koenig J.H.
        • Ranawat A.S.
        • Umans H.R.
        • Difelice G.S.
        Meniscal root tears: Diagnosis and treatment.
        Arthroscopy. 2009; 25: 1025-1032
        • Rosenberg T.D.
        • Scott S.M.
        • Coward D.B.
        • et al.
        Arthroscopic meniscal repair evaluated with repeat arthroscopy.
        Arthroscopy. 1986; 2: 14-20
        • Barrett G.R.
        • Richardson K.
        • Ruff C.G.
        • Jones A.
        The effect of suture type on meniscus repair. A clinical analysis.
        Am J Knee Surg. 1997; 10: 2-9
        • McCarty E.C.
        • Marx R.G.
        • DeHaven K.E.
        Meniscus repair: Considerations in treatment and update of clinical results.
        Clin Orthop Relat Res. 2002; : 122-134
        • Morgan C.D.
        The “all-inside” meniscus repair.
        Arthroscopy. 1991; 7: 120-125
        • Borden P.
        • Nyland J.
        • Caborn D.N.
        • Pienkowski D.
        Biomechanical comparison of the FasT-Fix meniscal repair suture system with vertical mattress sutures and meniscus arrows.
        Am J Sports Med. 2003; 31: 374-378
        • Gunes T.
        • Bostan B.
        • Erdem M.
        • Asci M.
        • Sen C.
        • Kelestemur M.H.
        Biomechanical evaluation of arthroscopic all-inside meniscus repairs.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 1347-1353
        • Haas A.L.
        • Schepsis A.A.
        • Hornstein J.
        • Edgar C.M.
        Meniscal repair using the FasT-Fix all-inside meniscal repair device.
        Arthroscopy. 2005; 21: 167-175
        • Kocabey Y.
        • Chang H.C.
        • Brand Jr., J.C.
        • Nawab A.
        • Nyland J.
        • Caborn D.N.
        A biomechanical comparison of the FasT-Fix meniscal repair suture system and the RapidLoc device in cadaver meniscus.
        Arthroscopy. 2006; 22: 406-413
        • Kotsovolos E.S.
        • Hantes M.E.
        • Mastrokalos D.S.
        • Lorbach O.
        • Paessler H.H.
        Results of all-inside meniscal repair with the FasT-Fix meniscal repair system.
        Arthroscopy. 2006; 22: 3-9
        • Cohen S.B.
        • Boyd L.
        • Miller M.D.
        Vascular risk associated with meniscal repair using Rapidloc versus FasT-Fix: Comparison of two all-inside meniscal devices.
        J Knee Surg. 2007; 20: 235-240
        • Anderson A.W.
        • LaPrade R.F.
        Common peroneal nerve neuropraxia after arthroscopic inside-out lateral meniscus repair.
        J Knee Surg. 2009; 22: 27-29
        • Krivic A.
        • Stanec S.
        • Zic R.
        • Budi S.
        • Milanovic R.
        • Stanec Z.
        Lesion of the common peroneal nerve during arthroscopy.
        Arthroscopy. 2003; 19: 1015-1018
        • Abouheif M.M.
        • Shibuya H.
        • Niimoto T.
        • et al.
        Determination of the safe penetration depth during all-inside meniscal repair of the posterior part of the lateral meniscus using the FasT-Fix suture repair system.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1868-1875
        • Baena A.E.
        • Castilla B.M.
        • Fernandez J.S.
        • de Rota Conde A.F.
        • Reina A.E.
        • Rubio F.E.
        Inside-out medial meniscus suture: An analysis of the risk of injury to the popliteal neurovascular bundle.
        Arthroscopy. 2011; 27: 516-521
        • Thiel W.
        The preservation of the whole corpse with natural color.
        Ann Anat. 1992; 174 ([in German]): 185-195
        • Deutsch A.
        • Wyzykowski R.J.
        • Victoroff B.N.
        Evaluation of the anatomy of the common peroneal nerve. Defining nerve-at-risk in arthroscopically assisted lateral meniscus repair.
        Am J Sports Med. 1999; 27: 10-15
        • Bernard M.
        • Grothues-Spork M.
        • Georgoulis A.
        • Hertel P.
        Neural and vascular complications of arthroscopic meniscal surgery.
        Knee Surg Sports Traumatol Arthrosc. 1994; 2: 14-18
      1. Complications in arthroscopy: The knee and other joints. Committee on Complications of the Arthroscopy Association of North America.
        Arthroscopy. 1986; 2: 253-258
      2. Complications of arthroscopy and arthroscopic surgery: Results of a national survey. Committee on Complications of Arthroscopy Association of North America.
        Arthroscopy. 1985; 1: 214-220
        • Cassard X.
        • Verdonk R.
        • Almqvist K.F.
        • et al.
        Meniscal repair.
        Rev Chir Orthop Reparatrice Appar Mot. 2004; 90 (suppl) [in French]: 3S49-S375
        • Keser S.
        • Savranlar A.
        • Bayar A.
        • Ulukent S.C.
        • Ozer T.
        • Tuncay I.
        Anatomic localization of the popliteal artery at the level of the knee joint: A magnetic resonance imaging study.
        Arthroscopy. 2006; 22: 656-659
        • Shetty A.A.
        • Tindall A.J.
        • Qureshi F.
        • Divekar M.
        • Fernando K.W.
        The effect of knee flexion on the popliteal artery and its surgical significance.
        J Bone Joint Surg Br. 2003; 85: 218-222
        • Allum R.
        Complications of arthroscopy of the knee.
        J Bone Joint Surg Br. 2002; 84: 937-945
        • Miller M.D.
        • Kline A.J.
        • Gonzales J.
        • Beach W.R.
        Pitfalls associated with FasT-Fix meniscal repair.
        Arthroscopy. 2002; 18: 939-943