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Assessing Risk of Iatrogenic Peroneal Nerve Injury in All-Inside Lateral Meniscal Repair Between Standard Vs.
Pramot Tanutit1, Pattira Boonsri1, Teeranan Laohawiriyakamol1
1Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
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.
Insights
Standard knee MRI may overestimate peroneal nerve injury risk during arthroscopic lateral meniscal repair. The study found risks are slightly higher than actual, but MRI remains a useful tool for assessing potential complications.
Area of Science:
- Orthopedic Surgery
- Radiology
- Biomedical Engineering
Background:
- Peroneal nerve injury risk during knee MRI has been studied.
- Knee positioning differs between standard MRI and arthroscopic lateral meniscal repair.
Purpose of the Study:
- To evaluate and compare peroneal nerve injury risk during simulated all-inside lateral meniscal repairs.
- To assess risk based on MRI scans with the knee in standard and arthroscopic positions.
Main Methods:
- Simulated all-inside lateral meniscal repair device passage on MRI scans.
- Measured distance from device path to peroneal nerve in standard (30° flexion) and figure-of-4 positions.
- Calculated "danger area" for potential iatrogenic injury.
Main Results:
- Distances to the peroneal nerve were significantly shorter in the standard MRI position compared to the arthroscopic position (p < 0.05).
- Danger areas from the arthroscopic position were contained within those of the standard position.
Conclusions:
- Standard knee MRI can assess peroneal nerve injury risk for arthroscopic lateral meniscal repair.
- Standard MRI slightly overestimates the risk of peroneal nerve injury.
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