Anatomical risk evaluation of iatrogenic injury to the infrapatellar branch of the saphenous nerve during medial meniscus arthroscopic surgery

Koch, Guillaume; Kling, Agathe; Ramamurthy, Nitin; Edalat, Faramarz; Cazzato, Roberto Luigi; Kahn, J.-L.; Garnon, Julien; Clavert, Philippe

doi:10.1007/s00276-016-1781-z

Cited by 13 publications

(8 citation statements)

References 33 publications

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“…[34] According to many authors, meniscal repair surgery can usually be applied at the following knee positions; varus/valgus stress in slight flexion (10-15°) or at 90-100° of flexion. [34,35] Cuéllar et al [15] in their study, where they measured distances between the suture material used and the peroneal nerve with the knee at 90°, 45°, and 0° of flexion, reported that the 90° of flexion is the safest knee flexion angle for repairing the meniscus. With the flexion of the knee, the posterior neurovascular structures go further away from the meniscal tissue.…”

Section: Discussionmentioning

confidence: 99%

Diz fleksiyon ve ekstansiyon pozisyonundayken içten-dışa menisküs tamiri sırasında iyatrojenik sinir hasarının anatomik muayenesi

Atbasi

Erdem

Neyisci

et al. 2019

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: In this study, we aim to assess the safe, risky and high-risky zones by measuring the proximity of the needles to the peroneal and saphenous nerves in millimeters for the repair of tears of the anterior, middle and posterior horns of the medial and lateral menisci at flexion and extension position during inside-out repair technique. METHODS: First, a cadaveric study was conducted on 10 cadaver knees in which both (lateral and medial) menisci were divided into anterior, corpus and posterior with the longitudinal tear simulating in each section. The next phase involved the suture of the simulated tears of the menisci while the knee was at 90° of flexion and full extension. Finally, the distance from the exit points of the K-wire being inserted through meniscal anterior, corpus and posterior tears to the aforementioned nerves was measured with a digital caliper. RESULTS: The distance between K-wire exit points and neurovascular structures concerning corpus and anterior horn tear repair of both menisci were considered far away and not included. However, closer posterior menisci measurements were taken to avoid the risk of iatrogenic nerve injury. The measured distances for lateral meniscus posterior tears were recorded 11±5.2 mm at 90° of flexion and 8±4.5 mm at extension, whereas those recorded 17.3±5.7 mm at 90° of flexion and 13.7±4.7 mm at extension for medial meniscus. These variables were evaluated statistically using a paired t-test; the mean of t value was not considered statistically significant. CONCLUSION: Our results show that the inside-out technique at knee flexion is safe even in the posterior meniscus tears. However, safety distance can be increased with the higher flexion degrees of the knee. Lastly, in posterior meniscal tear repair, we recommend either retractor assisted mini-open technique at knee flexion, or all-inside suture technique, to avoid nerve injury risk in this zone. Although many surgeons do not prefer inside-out techniques for posterior menisci tears, inside-out posterior meniscal repair of both menisci is as safe as an all-inside technique using retractor assisted mini-open technique with the knee at higher than 90° flexion.

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Section: Discussionmentioning

confidence: 99%

Diz fleksiyon ve ekstansiyon pozisyonundayken içten-dışa menisküs tamiri sırasında iyatrojenik sinir hasarının anatomik muayenesi

Atbasi

Erdem

Neyisci

et al. 2019

Ulus Travma Acil Cerrahi Derg

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“…Total knee arthroplasty is one of the most performed procedures in the world. However, this procedure, along with anterior cruciate ligament reconstruction, hamstring tendon harvest and medial meniscus surgery can often cause iatrogenic injury to the infrapatellar branch of the saphenous nerve (IPBSN), with rates ranging from 22.2 % to 69 % of patients (Koch et al, 2017;Ochiai et al, 2017;Henry et al, 2018). Furthermore, other procedures such as medial arthroscopic approaches and complementary posteromedial arthrotomies can cause injury to this nerve (Koch et al).…”

Section: Introductionmentioning

confidence: 99%

“…In addition, studies have aimed to assess the position of the IPBSN in order to observe patterns that might indicate a safer space for incision, although it is known that the IPBSN is highly variable (Kerver et al, 2013;Kalthur et al, 2015;Koch et al;Henry et al).…”

Section: Introductionmentioning

confidence: 99%

Anatomical Study of the Infrapatellar Branch of the Saphenous Nerve with Applications to Knee Surgery

et al. 2019

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The infrapatellar branch of the saphenous nerve is a cutaneous nerve that innervates the area surrounding the patella and contributes to the peripatellar plexus. This nerve is target to iatrogenic injuries during a great deal of knee procedures, such as tendon harvesting, total knee arthroplasty and medial arthroscopic approaches to the knee. Lesion to this nerve can produce sensorial loss at its innervation territory. The study conducted herein aims to observe the anatomical aspects of the infrapatellar branch in cadaveric specimens. The infrapatellar branch of the saphenous nerve of 40 male cadavers was dissected with the purpose of identifying the number of branches, its relation with the patella, tibial tuberosity and sartorius muscle. The nerve was dissected and several measurements were performed with the aid of a digital caliper. Statistical analysis was performed with the MedCalc 16.1 software. The infrapatellar branch of the saphenous nerve was present in 100 % of the sample. Its mean distance from its origin to its branching point was 16.35±6.48 mm on the right and 21.94±4.31 mm on the left, with statistically significant differences (p < 0.05). A relatively safe zone for surgery was observed on the superior and medial aspect of the patella, which received less branches.

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“…1,2 Iatrogenic peripheral nerve damage is a particularly common and devastating clinical entity that leads to significant pain and compromised functional outcomes. 2–4 For example, approximately 5% of patients undergoing arthroscopic hip repair suffer from transient neuropraxia. 5,6 Permanent damage to nerves is a well-known and debilitating health risk associated with peripheral, cranial, and spinal nerve access.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 Permanent damage to nerves is a well-known and debilitating health risk associated with peripheral, cranial, and spinal nerve access. 4 In such cases, intraoperative monitoring techniques, primarily involving evoked potentials as well as stimulated and spontaneous electromyography (EMG), provide surgeons with the ability to identify and assess vulnerable nerve sites by probing nerve-muscle activities during surgery. 7–12 Real-time monitoring strategies offer a powerful set of capabilities for surgeons that can positively affect outcomes, but existing intraoperative systems are large, expensive, and cumbersome; they include data acquisition consoles coupled to sensing electrode leads via multiple, fixed electrical connections.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative monitoring of neuromuscular function with soft, skin-mounted wireless devices

Wang

Tian

Raj³

et al. 2018

npj Digital Med

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Peripheral nerves are often vulnerable to damage during surgeries, with risks of significant pain, loss of motor function, and reduced quality of life for the patient. Intraoperative methods for monitoring nerve activity are effective, but conventional systems rely on bench-top data acquisition tools with hard–wired connections to electrode leads that must be placed percutaneously inside target muscle tissue. These approaches are time and skill intensive and therefore costly to an extent that precludes their use in many important scenarios. Here we report a soft, skin-mounted monitoring system that measures, stores, and wirelessly transmits electrical signals and physical movement associated with muscle activity, continuously and in real-time during neurosurgical procedures on the peripheral, spinal, and cranial nerves. Surface electromyography and motion measurements can be performed non-invasively in this manner on nearly any muscle location, thereby offering many important advantages in usability and cost, with signal fidelity that matches that of the current clinical standard of care for decision making. These results could significantly improve accessibility of intraoperative monitoring across a broad range of neurosurgical procedures, with associated enhancements in patient outcomes.

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Anatomical risk evaluation of iatrogenic injury to the infrapatellar branch of the saphenous nerve during medial meniscus arthroscopic surgery

Abstract: We defined a common anatomical course for the saphenous nerve and its infrapatellar branches. Then, three different areas were defined at risk for iatrogenic nerve injuries during medial meniscus.

Cited by 13 publications

References 33 publications

Diz fleksiyon ve ekstansiyon pozisyonundayken içten-dışa menisküs tamiri sırasında iyatrojenik sinir hasarının anatomik muayenesi

Diz fleksiyon ve ekstansiyon pozisyonundayken içten-dışa menisküs tamiri sırasında iyatrojenik sinir hasarının anatomik muayenesi

Anatomical Study of the Infrapatellar Branch of the Saphenous Nerve with Applications to Knee Surgery

Intraoperative monitoring of neuromuscular function with soft, skin-mounted wireless devices

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