The Risk of Iatrogenic Peroneal Nerve Injury in All-Inside Lateral Meniscus Repair Using a Vertical Stitch: A...

Area of Science:

• Orthopedic Surgery
• Anatomy
• Surgical Safety

Background:

• All-inside lateral meniscus repair near the popliteus tendon is technically challenging due to thin joint capsules, leading to high failure rates.
• Vertical suturing techniques for meniscus repair aim to improve stability but pose a risk of iatrogenic peroneal nerve injury.

Purpose of the Study:

• To assess the risk of iatrogenic peroneal nerve injury during all-inside lateral meniscus repair with vertical stitches.
• To compare injury risk between 90° and 120° of knee flexion using fresh-frozen cadavers.

Main Methods:

• Fifteen fresh-frozen cadavers underwent simulated all-inside lateral meniscus repairs using a straight device with 20-mm penetration depth.
• Repairs were randomized to the medial and lateral borders of the popliteus tendon at the peripheral and inner one-third regions.
• The shortest distance to the peroneal nerve was measured and compared between 90° and 120° knee flexion positions.

Main Results:

• Vertical stitch deployment at the inner one-third of the medial border of the popliteus tendon resulted in injury incidences of 10% (90° flexion) and 6.7% (120° flexion).
• Mean shortest distances to the peroneal nerve were significantly shorter at 90° flexion compared to 120° flexion when repairing the medial border.

Conclusions:

• Repairing the lateral meniscus at the lateral border of the popliteus tendon maintained a safe distance from the peroneal nerve.
• A small risk of iatrogenic injury persists at the inner one-third of the medial border, with 120° knee flexion offering a potentially safer margin.