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Updated: May 5, 2026

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Vascular safety during arthroscopic all-inside meniscus suture.

Akinobu Nishimura1, Aki Fukuda, Ko Kato

  • 1Department of Orthopaedic and Sports Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan, meiten@clin.medic.mie-u.ac.jp.

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA
|November 21, 2013
PubMed
Summary

Knee arthroscopy portal safety is enhanced in the figure-of-four position for meniscus repair, especially in anterior cruciate ligament (ACL)-deficient knees. Popliteal artery (PA) proximity varies by portal and knee position.

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Area of Science:

  • Orthopedic surgery
  • Anatomy
  • Medical imaging

Background:

  • Understanding the popliteal artery's (PA) position relative to knee arthroscopy portals is crucial for surgical safety.
  • The anteromedial and anterolateral portals are commonly used for meniscus repair and anterior cruciate ligament (ACL) reconstruction.

Purpose of the Study:

  • To assess the popliteal artery's (PA) orientation and distance from the anteromedial and anterolateral portals during knee arthroscopy.
  • To compare PA proximity in different knee positions and in patients with intact versus deficient ACLs.

Main Methods:

  • Magnetic resonance imaging (MRI) was used to evaluate PA distances in 97 patients (100 knees) at full extension and in the figure-of-four position.
  • Measurements were taken from the posterior tibial cortex and posterior cruciate ligament (PCL) to the PA relative to the patellar tendon borders.

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  • Comparison between intact and ACL-deficient knees was performed.

    • Main Results:

    • The PA was significantly farther from the posterior tibial cortex in the figure-of-four position compared to full extension.
    • PA distances were greater in ACL-deficient knees than intact knees at full extension.
    • The PA was obscured from the anteromedial portal by the PCL but remained accessible from the anterolateral portal.

    Conclusions:

    • All-inside meniscus repair through the anteromedial portal is safer in the figure-of-four position.
    • Performing meniscus repairs before ACL reconstruction is recommended due to PA positioning and portal accessibility.