Introduction

This simulation study on MRI of the knee was performed to assess the risk of injury to the popliteal artery (PA) and common peroneal nerve (CPN) during all-inside meniscal repairs in adults.

Methods

We simulated repair of the posterior horn of both medial (PHMM) and lateral menisci (PHLM) through anteromedial (AM) and anterolateral (AL) portals, using straight and curved devices, on 200 magnetic resonance imaging (MRI) scans taken with the knee in extension. For simulation using straight devices, the shortest distance from the menisco-capsular junction (MCJ) and the free edge of the meniscus to PA and CPN in vectors of AM and AL portals was measured. In curved devices, the closest extracapsular distance from the device tip to PA was measured.

Results

With a straight device through AM portal, the mean distance from the MCJ of PHMM to the PA was 20.7 ± 3.15 mm (13.5–27.4). In PHMM repair through AM portal using a curved device, the mean extracapsular distance from the device tip to PA was 18.8 ± 4 mm (7.7–27.2) while pointing toward and 26 ± 4.5 mm (15.5–35.6) while pointing away from the midline. When using straight devices, the average distance from free edge of LM to PA was 18.5 ± 3.3 mm (9.6–31.2) and from MCJ to PA was 8.9 ± 2.4 mm (3.5–18.8). The average distance measured from the MCJ to CPN through AM and AL portals using straight devices was 19.4 ± 2.8 mm (10.2–32.5) and 22 ± 2.8 mm (10.4–36.7) respectively.

Conclusion

In adults, PA is safe in PHMM repairs using both straight and curved devices irrespective of depth and direction of insertion. In PHLM repairs, the PA is at risk with both straight and curved devices. We recommend adjusting the depth of insertion to as minimum as possible to just penetrate the capsule. The CPN is safe in LM repairs using all-inside devices.

Level of Evidence

Level IV.

中文翻译：

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使用所有内部设备进行成人内侧半月板修复时，腘动脉是安全的：基于 MRI 的模拟研究

介绍

这项膝关节 MRI 模拟研究旨在评估成人全内侧半月板修复过程中腘动脉 (PA) 和腓总神经 (CPN) 受伤的风险。

方法

我们使用直线和弯曲装置，对膝关节进行的 200 次磁共振成像 (MRI) 扫描，通过前内侧 (AM) 和前外侧 (AL) 入口模拟修复内侧半月板 (PHMM) 和外侧半月板 (PHLM)在延伸中。对于使用直装置进行模拟，测量了 AM 和 AL 入口向量中从半月板-囊连接处 (MCJ) 和半月板自由边缘到 PA 和 CPN 的最短距离。在弯曲装置中，测量了从装置尖端到 PA 的最近囊外距离。

结果

使用通过 AM 入口的直装置，从 PHMM 的 MCJ 到 PA 的平均距离为 20.7 ± 3.15 mm (13.5–27.4)。在使用弯曲装置通过 AM 入口进行 PHMM 修复中，装置尖端到 PA 的平均囊外距离在指向中线时为 18.8 ± 4 mm (7.7–27.2)，在指向远离中线时为 26 ± 4.5 mm (15.5–35.6) 。使用直装置时，从 LM 自由边缘到 PA 的平均距离为 18.5 ± 3.3 mm (9.6–31.2)，从 MCJ 到 PA 的平均距离为 8.9 ± 2.4 mm (3.5–18.8)。使用直线装置通过 AM 和 AL 入口从 MCJ 到 CPN 的平均距离分别为 19.4 ± 2.8 mm (10.2–32.5) 和 22 ± 2.8 mm (10.4–36.7)。

结论

对于成人，无论插入深度和方向如何，使用直线和弯曲装置进行 PHMM 修复时 PA 都是安全的。在 PHLM 维修中，PA 因直装置和弯装置而面临风险。我们建议将插入深度调整到尽可能小，以刚好穿透胶囊。使用全内部设备进行 LM 维修时，CPN 是安全的。

证据水平

四级。