No risk of iatrogenic peroneal nerve injury in all-inside lateral meniscal repair with either 14- or 18-mm needles through the popliteus tendon in the standard arthroscopic knee conditions

Abstract

PurposeThe objectives of this prospective study were to evaluate the risk of peroneal nerve (PN) injury in simulated allinside lateral meniscal repair with sutures placed through the popliteus tendon (PT) and to determine the optimal needle length. Methods Twenty-nine axial magnetic resonance images (MRI) of postoperative knees with infused intra-articular luid and in a igure-of-four position were used. The cross-sectional length of the PT was divided into four equal parts with measurements performed at the 25%, 50% and 75% points according to their anteroposterior arrangement. Simulated repairs were performed with 14-mm and 18-mm straight needles via the anteromedial (AM) and anterolateral (AL) portals. Distances from the needle tip following full insertion through the PT to the PN and from the anterior PT border to the posterior knee capsule were measured to determine PN injury risk and ideal needle insertion depths at the diferent landmarks. Results Simulated repairs on the 29 knee MRI images resulted in no incidences of PN injury. The average distances from the needle tip to the PN of the 14-mm needle were signiicantly greater than the 18-mm needle in all the simulated repairs (P < 0.02), except at the 25% point in the AM approach. When using the 14-mm needle, capsule underpenetration was found in three knees (10.3%) at the 25% point during the AM approach, in one knee (3.4%) at the 50% and 75% points in the AM approach, and in all repairs from the AL portal. The average distances from the anterior PT border to the capsule at the 25%, 50%, and 75% division points on the PT in the AM approach were 7.7 ± 2.7 mm, 7.9 ± 2.5 mm and 7.6 ± 2.8 mm, respectively, whilst in the AL approach were 8.4 ± 2.9 mm, 8.1 ± 2.8 mm and 7.6 ± 2.7 mm. Conclusion Simulated all-inside lateral meniscal repair with suture placement through the PT with 14-mm and 18-mm needles was safe. The measurements in this study can be used to determine potential PN injury risk in relation to the PT and the appropriate needle length for safe lateral meniscal repairs.

Assessing Risk of Iatrogenic Peroneal Nerve Injury in All-Inside Lateral Meniscal Repair Between Standard Vs. Arthroscopic MRI

“…Axial oblique MRI scans passing through the center of the lateral meniscal tissue were used for the study measurements, with the medial border of the patella chosen as the position of the anteromedial portal and the lateral border of the patella chosen as the anterolateral portal. The risk of iatrogenic peroneal nerve injury was evaluated by drawing a direct line from the anteromedial or anterolateral portal to the medial or lateral border of the popliteus tendon, extending 14 mm beyond the joint capsule, following the recommendations from earlier studies 9,15,16 . The shortest distance was measured from the direct line to the outer border of the peroneal nerve (Fig.…”