Identifying Risk Zones for Neurovascular Injury in Pediatric All-Inside Arthroscopic Lateral Meniscal Repair

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Knee Arthroscopy

Background:

• All-inside meniscal repair techniques offer benefits like reduced operative time and fewer incisions.
• However, a significant concern is iatrogenic neurovascular injury during arthroscopic meniscal repairs.

Purpose of the Study:

• To identify risk zones and injury incidence for the common peroneal nerve (CPN) and popliteal artery.
• To evaluate these risks in relation to the popliteal tendon (PT) using anterolateral (AL) and anteromedial (AM) portals in pediatric patients undergoing simulated all-inside meniscal repair.

Main Methods:

• A descriptive laboratory study using axial knee MRI scans from 124 patients.
• Simulated all-inside technique by drawing lines from AM and AL portals to the PT borders.
• Assessed projected iatrogenic injury risk to the CPN and popliteal artery, defining "risk zones".

Main Results:

• Higher CPN injury risk from AL portal (45%) vs. AM portal (19%) for lateral PT edge repair (P < .001).
• Higher peroneal nerve injury risk from AM portal (29%) vs. AL portal (8.9%) for medial PT edge repair (P < .001).
• Specific millimeters of risk zone extension from PT edges for both portals during lateral meniscus body repair were recorded.

Conclusions:

• The AM portal is safer for lateral meniscus body repair near the lateral PT edge.
• The AL portal is safer for lateral meniscus body repair near the medial PT edge.
• Understanding these portal-specific risk profiles aids surgeons in minimizing neurovascular injury during pediatric meniscal repairs.