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Mori Y, Kamiya T, Okimura S, Shiwaku K, Okada Y, Teramoto A, Yamashita T. Minimizing the risk of injury to the popliteal artery during pullout repair of medial meniscus posterior root tears: A cadaveric study. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 35:81-84. [PMID: 38261907 PMCID: PMC10797534 DOI: 10.1016/j.asmart.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/30/2023] [Indexed: 01/25/2024] Open
Abstract
Background The purpose of this study was to investigate the positional effect of guide pins used in the transtibial pullout repair of medial meniscus posterior root tears on the popliteal artery. Methods We used eight cadaveric knees. Two 2.4-mm guide pins were inserted into the posterior root of the medial meniscus at 50° to the articular surface from the medial edge of the tibial tuberosity (anteromedial group) and the anterior edge of the medial collateral ligament (posteromedial group) using an aiming guide placed at the posterior root attachment of the medial meniscus from the anteromedial portal. The posterior capsule was dissected, and the popliteal artery was identified. The positional effect of the guide pins on the popliteal artery was photographed arthroscopically at 0°, 30°, 60°, and 90° knee flexion angles. The popliteal artery diameter and the minimum distance between the popliteal artery center and the guide pin tip were measured. Results At 90° knee flexion, most of the guide pins in the anteromedial (6 knees; 75 %) and posteromedial groups (7 knees; 87.5 %) collided with the femoral intercondylar wall. The rate of collision was significantly higher at the 90° knee flexion position than that at other angles (p = 0.02). The average shortest distance between the popliteal artery center and the guide pin tip at 0° knee flexion in the posteromedial group (5.4 mm ± 3.4 mm) was significantly greater than that at other knee flexion angles, although the mean distance in the posteromedial group was so negligible that the guide pin could penetrate the popliteal artery. Conclusions Knee flexion at 90° causes less damage to the popliteal artery during the transtibial pullout repair of medial meniscus posterior root tears.
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Affiliation(s)
- Yuta Mori
- Department of Orthopaedic Surgery, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Hokkaido, Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Hokkaido, Japan
| | - Shinichiro Okimura
- Department of Orthopaedic Surgery, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Hokkaido, Japan
| | - Kousuke Shiwaku
- Department of Orthopaedic Surgery, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Hokkaido, Japan
| | - Yohei Okada
- Department of Orthopaedic Surgery, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Hokkaido, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Hokkaido, Japan
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Shamseer CM, Nizaj N, Thomas AB, Kandathil JC, Theruvil B. The Popliteal Artery is Safe in Medial Meniscal Repair Using All Inside Devices in Adults: An MRI-Based Simulation Study. Indian J Orthop 2022; 56:2077-2085. [PMID: 36507197 PMCID: PMC9705615 DOI: 10.1007/s43465-022-00755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/15/2022] [Indexed: 02/04/2023]
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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Affiliation(s)
| | - N. Nizaj
- Department of Orthopedics, VPS Lakeshore Hospital, Kochi, India
| | | | | | - Bipin Theruvil
- Department of Orthopedics, VPS Lakeshore Hospital, Kochi, India
- Present Address: Arthroplasty and Sports Medicine, Medical Trust Hospital, Ernakulam, India
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Oehler N, Foerg A, Haenle M, Blanke F, Vogt S. Assessment of popliteal neurovascular safety during all-inside suturing of the posterior horn of the lateral meniscus using Upright MRIs of the knee joint. Knee 2021; 33:234-242. [PMID: 34717095 DOI: 10.1016/j.knee.2021.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/21/2021] [Accepted: 10/03/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND To examine the risk of injury to the popliteal neurovascular bundle (pNVB) during all-inside repair of the posterior horn of the lateral meniscus (PHLM) using Upright-MRIs. METHODS Upright-MRIs of 61 knees in extension (ext) and 90°-flexion (flex) were included. Distance D from the PHLM to the pNVB was compared between extended and 90°-flexed position, subgroups with/without joint-effusion and evaluated according to demographics. Portal safety was assessed simulating suturing of the PHLM via four arthroscopy portals. Distance d (shortest space from the simulated suturing-device trajectory lines to the pNVB) was compared among portals in increasing distances from the posterior cruciate ligament (PCL). RESULTS D is longer in flex (17.3 ± 6.0 mm) than in ext (11.3 ± 4.2 mm, p < 0.0001). MRIs with joint-effusion displayed longer values of D than scans without joint-effusion (flex: 20.4 ± 7.1 mm vs. 16.1 ± 5.2 mm, p = 0.012). Shorter distances are associated with female gender, lower body weight and lower BMI. At 0 mm from the PCL, the 1 cm-lateral portal was the safest (p < 0.0001) whereas at 3 mm/6mm/9mm/12 mm the 1 cm-medial portal showed the longest d values (p < 0.0001 each). CONCLUSION All-inside suturing of the PHLM is safer in 90°-flexion, in presence of intraarticular fluid and in male patients with increasing weight/BMI. Sutures of the PHLM at 0 mm from the PCL are safer from a 1 cm-lateral portal whereas for tears located ≥ 3 mm from the PCL a 1 cm-medial portal involves a lower neurovascular risk. Upright-MRI proves excellent for preoperative planning to minimize neurovascular risks.
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Affiliation(s)
- Nicola Oehler
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung, Augsburg, Germany.
| | - Andreas Foerg
- Institute for Upright MRI Munich, Aschheim/Munich, Germany.
| | - Maximilian Haenle
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung, Augsburg, Germany; Clinic and Policlinic for Orthopedic Surgery, University Rostock, Rostock, Germany.
| | - Fabian Blanke
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung, Augsburg, Germany; Clinic and Policlinic for Orthopedic Surgery, University Rostock, Rostock, Germany; Department for Orthopedic Surgery, Schoen Klinik Munich Harlaching, Munich, Germany.
| | - Stephan Vogt
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung, Augsburg, Germany; Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Technical University Munich, Klinikum Rechts der Isar, Munich, Germany.
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Meniscus Repair Techniques. Sports Med Arthrosc Rev 2021; 29:e34-e43. [PMID: 34398120 DOI: 10.1097/jsa.0000000000000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The menisci play a vital role in maintaining knee function and protecting the chondral surfaces. Acute and chronic tears are common injuries among both young athletes and older patients with early degenerative changes. The progression of physiological derangement and chondral injury after meniscus injury and meniscectomy have prompted interest in expanding meniscus repair techniques. Recent literature encourages an attempt at repair in tear patterns previously declared irreparable if the tissue quality allows. The orthopedic surgeon should understand the multitude of techniques available to them and be prepared to combine techniques to optimize the quality of their repair construct. While biological augmentation may show some promising early results, the quality of the current data precludes strong recommendations in their favor.
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