Purpose
To establish a safe zone for all-inside meniscal fixation in pediatric patients by
use of magnetic resonance imaging (MRI) measurements between the popliteal tendon
(PT) and popliteal neurovascular bundle (PNVB).
Methods
Patients aged 5 to 16 years with normal or nearly normal knee MRI scans were included.
They were grouped by age: group I, 5 to 7 years (n = 61); group II, 8 to 10 years
(n = 59); group III, 11 to 13 years (n = 60); and group IV, 14 to 16 years (n = 70).
At the level of the lateral meniscus, 2 lines starting at the lateral patellar tendon
border and ending at the medial edge of the PT (D1) and the lateral edge of the PNVB
(D2) were made on an axial knee MRI scan. A third line (D3) connected D1 to D2 at
the meniscocapsular junction of the posterior horn of the lateral meniscus (PHLM).
A fourth line (D4), derived geometrically, was parallel and 8 mm anterior to D3, simulating
the anterior edge of the PHLM.
Results
Axial MRI scans of 250 pediatric patients (aged 5-16 years) were retrospectively reviewed.
Analysis showed significant correlation between age and sex for D3 (P < .0001). For D3, there were significant differences among all age groups, except
between groups III and IV. The average D3 by age group was 14.1 mm (standard deviation
[SD], 3.1 mm) for group I, 15.8 mm (SD, 2.5 mm) for group II, 17.0 mm (SD, 3.3 mm)
for group III, and 17.2 mm (SD, 3.1 mm) for group IV. The average D4 was 11.39 mm
(SD, 2.6 mm), 13.24 mm (SD, 2.24 mm), 14.59 mm (SD, 2.89 mm), and 14.80 mm (SD, 2.79 mm),
respectively. There were significant differences in D3 and D4 in male versus female
patients (17.6 mm vs 15.7 mm, P < .001, and 14.9 mm vs 13.2 mm, P < .001, respectively), particularly in groups III and IV (17.0 mm vs 13.8 mm and
16.8 mm vs 13.9 mm, respectively).
Conclusions
This study provides normative data of the distance between the PNVB and PT at the
meniscocapsular junction (D3) and anterior edge of the PHLM (D4) with the knee in
full extension. Combined with previous studies showing that the addition of knee flexion
increases the distance between the meniscus and the neurovascular bundle, these data
can be used by surgeons to improve the safety of PHLM repair in pediatric patients.
Level of Evidence
Level III, diagnostic study of nonconsecutive patients.
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Article info
Publication history
Accepted:
July 30,
2018
Received:
April 18,
2018
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2018 by the Arthroscopy Association of North America
