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The Danger Zone for Iatrogenic Neurovascular Injury in All-Inside Lateral Meniscal Repair in Relation to the Popliteal Tendon: An MRI Study

BACKGROUND: Lateral meniscal repair can endanger the nearby neurovascular structure (peroneal nerve or popliteal artery). To our knowledge, there have been no studies to evaluate the danger zone of all-inside meniscal repair through the anteromedial (AM) and anterolateral (AL) portals in relation to...

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Autores principales: Chuaychoosakoon, Chaiwat, Wuttimanop, Watit, Tangjatsakow, Preyanun, Charoenrattanawat, Sasathorn, Parinyakhup, Wachiraphan, Boonriong, Tanarat, Chernchujit, Bancha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8493316/
https://www.ncbi.nlm.nih.gov/pubmed/34631905
http://dx.doi.org/10.1177/23259671211038397
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author Chuaychoosakoon, Chaiwat
Wuttimanop, Watit
Tangjatsakow, Preyanun
Charoenrattanawat, Sasathorn
Parinyakhup, Wachiraphan
Boonriong, Tanarat
Chernchujit, Bancha
author_facet Chuaychoosakoon, Chaiwat
Wuttimanop, Watit
Tangjatsakow, Preyanun
Charoenrattanawat, Sasathorn
Parinyakhup, Wachiraphan
Boonriong, Tanarat
Chernchujit, Bancha
author_sort Chuaychoosakoon, Chaiwat
collection PubMed
description BACKGROUND: Lateral meniscal repair can endanger the nearby neurovascular structure (peroneal nerve or popliteal artery). To our knowledge, there have been no studies to evaluate the danger zone of all-inside meniscal repair through the anteromedial (AM) and anterolateral (AL) portals in relation to the medial and lateral edges of the popliteal tendon (PT). PURPOSE: To establish the risk of neurovascular injury and the danger zone in repairing the lateral meniscus in relation to the medial and lateral edges of the PT. STUDY DESIGN: Descriptive laboratory study. METHODS: Using axial magnetic resonance imaging (MRI) studies at the level of the lateral meniscus, lines were drawn to simulate a straight, all-inside meniscal repair device, drawn from the AM and AL portals to both the medial and lateral edges of the PT. In cases in which the line passed through the neurovascular structure, a risk of iatrogenic neurovascular injury was deemed, and measurements were made to determine the danger zones of neurovascular injury in relation to the medial or lateral edges of the PT. RESULTS: Axial MRI images of 240 adult patients were reviewed retrospectively. Repairing the body of the lateral meniscus through the AM portal had a greater risk of neurovascular injury than repairs made through the AL portal in relation to the medial edge of the PT (P = .006). The danger zone in repairing the lateral meniscus through the AM portal extended 1.82 ± 1.68 mm laterally from the lateral edge of the PT and 3.13 ± 2.45 mm medially from the medial edge of the PT. Through the AL portal, the danger zone extended 2.81 ± 1.94 mm laterally from the lateral edge of the PT and 1.39 ± 1.53 mm medially from the medial edge of the PT. CONCLUSION: Repairing the lateral meniscus through either the AM or the AL portals in relation to the PT can endanger the peroneal nerve or popliteal artery. CLINICAL RELEVANCE: The surgeon can minimize the risk of iatrogenic neurovascular injury in lateral meniscal repair by avoiding using the all-inside meniscal device in the danger zone area as described in this study.
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spelling pubmed-84933162021-10-07 The Danger Zone for Iatrogenic Neurovascular Injury in All-Inside Lateral Meniscal Repair in Relation to the Popliteal Tendon: An MRI Study Chuaychoosakoon, Chaiwat Wuttimanop, Watit Tangjatsakow, Preyanun Charoenrattanawat, Sasathorn Parinyakhup, Wachiraphan Boonriong, Tanarat Chernchujit, Bancha Orthop J Sports Med Article BACKGROUND: Lateral meniscal repair can endanger the nearby neurovascular structure (peroneal nerve or popliteal artery). To our knowledge, there have been no studies to evaluate the danger zone of all-inside meniscal repair through the anteromedial (AM) and anterolateral (AL) portals in relation to the medial and lateral edges of the popliteal tendon (PT). PURPOSE: To establish the risk of neurovascular injury and the danger zone in repairing the lateral meniscus in relation to the medial and lateral edges of the PT. STUDY DESIGN: Descriptive laboratory study. METHODS: Using axial magnetic resonance imaging (MRI) studies at the level of the lateral meniscus, lines were drawn to simulate a straight, all-inside meniscal repair device, drawn from the AM and AL portals to both the medial and lateral edges of the PT. In cases in which the line passed through the neurovascular structure, a risk of iatrogenic neurovascular injury was deemed, and measurements were made to determine the danger zones of neurovascular injury in relation to the medial or lateral edges of the PT. RESULTS: Axial MRI images of 240 adult patients were reviewed retrospectively. Repairing the body of the lateral meniscus through the AM portal had a greater risk of neurovascular injury than repairs made through the AL portal in relation to the medial edge of the PT (P = .006). The danger zone in repairing the lateral meniscus through the AM portal extended 1.82 ± 1.68 mm laterally from the lateral edge of the PT and 3.13 ± 2.45 mm medially from the medial edge of the PT. Through the AL portal, the danger zone extended 2.81 ± 1.94 mm laterally from the lateral edge of the PT and 1.39 ± 1.53 mm medially from the medial edge of the PT. CONCLUSION: Repairing the lateral meniscus through either the AM or the AL portals in relation to the PT can endanger the peroneal nerve or popliteal artery. CLINICAL RELEVANCE: The surgeon can minimize the risk of iatrogenic neurovascular injury in lateral meniscal repair by avoiding using the all-inside meniscal device in the danger zone area as described in this study. SAGE Publications 2021-10-04 /pmc/articles/PMC8493316/ /pubmed/34631905 http://dx.doi.org/10.1177/23259671211038397 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Chuaychoosakoon, Chaiwat
Wuttimanop, Watit
Tangjatsakow, Preyanun
Charoenrattanawat, Sasathorn
Parinyakhup, Wachiraphan
Boonriong, Tanarat
Chernchujit, Bancha
The Danger Zone for Iatrogenic Neurovascular Injury in All-Inside Lateral Meniscal Repair in Relation to the Popliteal Tendon: An MRI Study
title The Danger Zone for Iatrogenic Neurovascular Injury in All-Inside Lateral Meniscal Repair in Relation to the Popliteal Tendon: An MRI Study
title_full The Danger Zone for Iatrogenic Neurovascular Injury in All-Inside Lateral Meniscal Repair in Relation to the Popliteal Tendon: An MRI Study
title_fullStr The Danger Zone for Iatrogenic Neurovascular Injury in All-Inside Lateral Meniscal Repair in Relation to the Popliteal Tendon: An MRI Study
title_full_unstemmed The Danger Zone for Iatrogenic Neurovascular Injury in All-Inside Lateral Meniscal Repair in Relation to the Popliteal Tendon: An MRI Study
title_short The Danger Zone for Iatrogenic Neurovascular Injury in All-Inside Lateral Meniscal Repair in Relation to the Popliteal Tendon: An MRI Study
title_sort danger zone for iatrogenic neurovascular injury in all-inside lateral meniscal repair in relation to the popliteal tendon: an mri study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8493316/
https://www.ncbi.nlm.nih.gov/pubmed/34631905
http://dx.doi.org/10.1177/23259671211038397
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