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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Article Info
Publication History
Published online: July 08, 2015
Accepted:
April 30,
2015
Received:
August 21,
2014
Footnotes
The authors report the following potential conflict of interest or source of funding: M.A.R.-I. receives support from Smith & Nephew.
Identification
Copyright
© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
