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The Popliteal Artery is Safe in Medial Meniscal Repair Using All Inside Devices in Adults: An MRI-Based Simulation Study

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Abstract

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.

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Abbreviations

PA:

Popliteal artery

PT:

Patellar tendon

CPN:

Common peroneal nerve

MCJ:

Menisco-capsular junction

LTE:

Lateral tibial eminence

MTE:

Medial tibial eminence

AM:

Anteromedial

AL:

Anterolateral

LM:

Lateral meniscus

MM:

Medial meniscus

PHMM:

Posterior horn of the medial meniscus

PHLM:

Posterior horn of the lateral meniscus

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Bipin Theruvil

    Present address: Arthroplasty and Sports Medicine, Medical Trust Hospital, Ernakulam, India

Authors and Affiliations

  1. Department of Orthopedics, VPS Lakeshore Hospital, Kochi, India

    C. Muhammed Shamseer, N. Nizaj, Appu Benny Thomas & Bipin Theruvil

  2. Department of Radiology, VPS Lakeshore Hospital, Kochi, India

    Julio Chacko Kandathil

Authors
  1. C. Muhammed Shamseer
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  2. N. Nizaj
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  3. Appu Benny Thomas
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Contributions

CMS carried out the data collection, was involved in the performance of the simulation study, did the measurements, and drafted the manuscript. NN did the measurements and simulations. He was also involved in writing the manuscript. ABT analyzed the data. JCK is the radiologist who reported the MRI. BT is the senior author. He designed the study, performed the evaluation and the correction of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bipin Theruvil.

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The authors declare that they have no relevant financial or non-financial interests to disclose.

Ethical approval

Prior ethical approval was obtained from the committee for Ethical Human research at our hospital (approval no. LHRC/EC/10/2019).

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Informed consent was obtained from all patients.

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Shamseer, C.M., Nizaj, N., Thomas, A.B. et al. The Popliteal Artery is Safe in Medial Meniscal Repair Using All Inside Devices in Adults: An MRI-Based Simulation Study. JOIO 56, 2077–2085 (2022). https://doi.org/10.1007/s43465-022-00755-9

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