The safe establishment of a transseptal portal in the posterior knee

Kim, Sung Jae; Song, Ho Taek; Moon, Hong Kyo; Chun, Yong-Min; Chang, Woo Hyuk

doi:10.1007/s00167-011-1429-9

Cited by 35 publications

(45 citation statements)

References 21 publications

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“…25 Another technical point consists in performing the transseptal portal from the medial to the lateral direction to decrease the rate of knee vascular injury. 18 Another recommendation during open surgery consists of the release (or detachment) of the capsule in the tibial portion, which is less vascularized than the femoral portion, preserving the MGA. 18 …”

Section: Discussionmentioning

confidence: 99%

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Relationship Between the Middle Genicular Artery and the Posterior Structures of the Knee

Carvalho

Ramos

Novaretti

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:The middle genicular artery (MGA) is responsible for the blood supply to the cruciate ligaments and synovial tissue. Traumatic sports injuries and surgical procedures (open and arthroscopic) can cause vascular damage. Little attention has been devoted to establish safe parameters for the MGA.Purpose:To investigate the anatomy of the MGA and its relation to the posterior structures of the knees, mainly the posterior capsule and femoral condyles, and to establish safe parameters to avoid harming the MGA.Study Design:Descriptive laboratory study.Methods:Dissection of the MGA was performed in 16 fresh, unpaired adult human cadaveric knees with no macroscopic degenerative or traumatic changes and no previous surgeries. The specimens were meticulously evaluated with emphasis on preservation of the MGA. The distances from the MGA to the medial and lateral femoral condyles were measured. The Mann-Whitney test was used for statistical analysis.Results:In all specimens, the MGA emerged from the anterior aspect of the popliteal artery, distal to the superior genicular arteries, and had a short distal trajectory toward the posterior capsule where it entered proximal to the oblique popliteal ligament. The artery lay in the midportion between the condyles. The distance between the posterior aspect of the tibia and the point of entry of the MGA into the posterior joint capsule was 23.8 ± 7.3 mm (range, 14.72-35.68 mm). There was no correlation between an individual’s height and the distance of the entrance point of the MGA into the posterior joint capsule to the posterior superior corner of the tibia.Conclusion:The middle genicular artery lies in the midportion between the medial and lateral femoral condyles.Clinical Relevance:This knowledge is important for the preservation of the blood supply during posterior knee surgical procedures and to settle a secure distance between the posterior aspect of the tibia and the MGA input. This could decrease and prevent iatrogenic vascular injury risk to the MGA.

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Section: Discussionmentioning

confidence: 99%

“…18 Another recommendation during open surgery consists of the release (or detachment) of the capsule in the tibial portion, which is less vascularized than the femoral portion, preserving the MGA. 18 …”

Section: Discussionmentioning

confidence: 99%

Relationship Between the Middle Genicular Artery and the Posterior Structures of the Knee

Carvalho

Ramos

Novaretti

et al. 2016

Orthopaedic Journal of Sports Medicine

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“…both the dimensions of the posteromedial and lateral compartments, in addition to the relationship between the PCL and popliteal artery to improve on the safety of this technique. [13][14][15][16] These studies have established that the safe margin of the posteromedial compartment is consistently wider than that of the posterolateral compartment, and that the popliteal artery is consistently located lateral to the posterior septum. 15 Thus, injury to the popliteal artery can be better avoided by penetrating the septum lateral to medial.…”

mentioning

confidence: 98%

“…[13][14][15][16] These studies have established that the safe margin of the posteromedial compartment is consistently wider than that of the posterolateral compartment, and that the popliteal artery is consistently located lateral to the posterior septum. 15 Thus, injury to the popliteal artery can be better avoided by penetrating the septum lateral to medial. 15 While the relationship between the PCL, posterior compartments, transseptal portal, and popliteal artery has been successfully measured both indirectly through magnetic resonance imaging and under arthroscopic cadaveric conditions in prior studies, the techniques used for measurement involved extensive dissection and posterior capsulotomy, making the results more difficult to interpret in a clinical context.…”

mentioning

confidence: 98%

“…15 Thus, injury to the popliteal artery can be better avoided by penetrating the septum lateral to medial. 15 While the relationship between the PCL, posterior compartments, transseptal portal, and popliteal artery has been successfully measured both indirectly through magnetic resonance imaging and under arthroscopic cadaveric conditions in prior studies, the techniques used for measurement involved extensive dissection and posterior capsulotomy, making the results more difficult to interpret in a clinical context. The purpose of this study was to use fluoroscopy to measure the distance between the transseptal portal and the popliteal artery under realistic arthroscopic conditions with an intact posterior knee capsule, and to determine any difference in this distance between knee flexion and extension.…”

mentioning

confidence: 99%

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The Transseptal Arthroscopic Knee Portal Is in Close Proximity to the Popliteal Artery: A Cadaveric Study

et al. 2017

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The purpose of this study was to use fluoroscopy to measure the distance between the transseptal portal and the popliteal artery under arthroscopic conditions with an intact posterior knee capsule, and to determine the difference between 90 degrees of knee flexion and full extension. The popliteal artery of eight fresh-frozen cadaveric knees was dissected and cannulated proximal to the knee joint. The posterolateral, posteromedial, and transseptal portals were then established at 90 degrees of flexion. A 4-mm switching stick was placed through the transseptal portal, and barium contrast was injected into the popliteal artery. A lateral fluoroscopic image was taken with the knee in 90 degrees of flexion and full extension, and the distance between the popliteal artery and the switching stick was measured and compared using a paired -test. In knee flexion, the average distance between the transseptal portal and the anterior aspect of the popliteal artery for the eight cadaveric specimens was 12.0 mm ± 3.3 mm; in extension, this decreased to 9.0 mm ± 2.7 mm. The distance between the transseptal portal and popliteal artery was significantly higher at 90 degrees of knee flexion as compared with extension ( = 0.0005). The transseptal posterior knee arthroscopic portal must be carefully created due to the close proximity to the popliteal artery, and may be closer to the artery than previously reported in specimens with an intact posterior knee capsule. Creating the portal with the knee in flexion significantly displaces the popliteal artery away from the portal reducing the risk of arterial injury.

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