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

Annat Houston1, Casey McDonald1, Andrew Eck1

  • 1Department of Orthopedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.

Orthopaedic Journal of Sports Medicine
|March 7, 2025
PubMed

Insights

All-inside meniscal repair poses risks to nerves and blood vessels. This study identifies safer portal use for pediatric knee surgery, reducing iatrogenic injury risk.

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.
Abstract

Keywords:
all-insidearthroscopymeniscal repair

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