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

Impact of lower limb alignment abnormality (physiologic knee valgus) on the functional recovery outcome of athletes with meniscal injuries

OBJECTIVE

This study aimed to investigate the impact of lower limb alignment abnormalities, specifically physiological knee valgus, on the functional recovery outcomes of athletes with meniscal injuries. It also examined the factors influencing these abnormalities to provide scientific evidence for treatment and rehabilitation of related sports injuries.

METHODS

We conducted a retrospective study of 118 athletes from Guizhou Normal University, who were divided into two groups based on the presence or absence of lower limb alignment abnormalities. The Simple group comprised athletes with isolated meniscal injuries, while the Combined group included athletes with meniscal injuries and concurrent lower limb alignment abnormalities. We assessed the functional status of both groups and analyzed factors influencing lower limb alignment abnormalities.

RESULTS

Of the 118 athletes, 46 (38.98%) exhibited lower limb alignment abnormalities, and 72 (61.02%) did not. No significant differences in general characteristics were found between the groups (all P > 0.05). The Combined group displayed higher Visual Analog Scale (VAS) scores and Functional Performance Test (FPT) results (coordinated contraction, shuttle run, CarioCa) compared to the Simple group (P < 0.05). Conversely, joint range of motion (ROM), knee muscle strength (flexors), and International Knee Documentation Committee (IKDC) scores were lower in the Combined group (all P < 0.05). Multivariate logistic regression analysis identified active ROM < 105.32°, passive ROM < 101.66°, and knee muscle strength (flexors) < 84.41 N as risk factors for lower limb alignment abnormalities (P < 0.05), while FPT acted as a protective factor (P < 0.05). The combined testing model demonstrated higher predictive efficacy (AUC = 0.903, 95% CI: 0.852-0.955, P < 0.001).

CONCLUSION

Lower limb alignment abnormalities significantly affect the functional recovery outcomes of athletes with meniscal injuries. Factors such as ROM, knee muscle strength, and IKDC score may pose risks for these abnormalities, whereas FPT can provide protective benefits. Timely detection and correction of lower limb alignment abnormalities during the rehabilitation process from meniscal injuries are crucial to enhance recovery and improve prognosis.

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

BACKGROUND

Various studies have examined the risk of peroneal nerve injury with use of standard magnetic resonance imaging (MRI) of the knee. However, the position of the knee during standard MRI is different from that during an actual arthroscopic lateral meniscal repair. The purpose of the present study was to evaluate and compare the risk of peroneal nerve injury during simulated all-inside lateral meniscal repairs on the basis of MRI scans made with the knee in both positions.

METHODS

With use of axial MRI scans made with the knee in the standard position (i.e., in 30° of flexion) and in the actual position used during arthroscopic lateral meniscal repair (i.e., in a figure-of-4 position), direct lines were drawn to simulate the passage of a straight all-inside meniscal repair device from the anteromedial and anterolateral portals to the medial and lateral borders of the popliteus tendon. The distance from the closest passage of each line to the peroneal nerve was measured. If a line touched or passed through the peroneal nerve, a risk of iatrogenic injury was noted and a new line was drawn from the same portal to the outer border of the peroneal nerve. The danger area was measured from the first line to the new line along the joint capsule.

RESULTS

In 28 Thai patients, the shortest distances from each line to the peroneal nerve were significantly shorter on the MRI scans made with the knee in the standard position than on those made with the knee in the arthroscopic position (p < 0.05 for all). All danger areas on the MRI scans that were made with the knee in the arthroscopic position were included within the danger areas on the scans that were made with the knee in the standard position.

CONCLUSIONS

Standard MRI scans of the knee can be used to determine the risk of peroneal nerve injury at the time of arthroscopic lateral meniscal repair, although the risks are slightly overestimated.

LEVEL OF EVIDENCE

Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.