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All-Inside Meniscal Implant Placement and Risks of Neurovascular Injury: An Arthroscopic, Pediatric Anatomic Study
Henry B G Baird1, Yi-Meng Yen2, Wills Baird3
1Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Insights
Pediatric all-inside meniscal repair devices show safe proximity to neurovascular structures, particularly the popliteal artery, vein, and tibial nerve. This study provides crucial data for pediatric knee surgery safety.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Biomedical Engineering
Background:
- Pediatric meniscal injury and arthroscopic repair rates are increasing.
- All-inside devices are gaining popularity for pediatric meniscal repair.
- There is a need to assess the proximity of these devices to neurovascular structures in pediatric knees.
Purpose of the Study:
- To measure distances between arthroscopically placed all-inside lateral meniscal devices and key neurovascular structures in pediatric cadaveric knees.
- To evaluate potential risks associated with specific device placements and approach angles.
- To test the hypothesis that neurovascular structures are closely located to these devices, especially at the posterior root and popliteal hiatus.
Main Methods:
- A descriptive laboratory study was conducted on 12 pediatric cadaveric knee specimens (ages 6-10).
- Two all-inside meniscal repair implants were placed in the lateral meniscus: one at the posterior root via a lateral portal and one at the popliteal hiatus via a medial portal.
- Post-dissection measurements were taken between implants and the popliteal artery (PA), popliteal vein (PV), tibial nerve (TN), and peroneal nerve (PN).
Main Results:
- Distances to neurovascular structures ranged from 2.3 to 63.0 mm.
- Implants at the meniscus root were significantly closer to the PA, PV, and TN compared to implants at the popliteal hiatus (P≤.001).
- No significant difference in proximity to the peroneal nerve was found between the two implant positions (P=.06).
Conclusions:
- All-inside devices, particularly those placed at the posterior horn using the anterolateral portal, are in close proximity to neurovascular structures in pediatric knees.
- Based on this study's conditions, all-inside meniscal repair devices appear to be safe for pediatric use.
- The findings contribute essential data to the understanding of pediatric meniscal injuries and repair techniques.
Background:
Pediatric meniscal injury rates and their arthroscopic repair are on the rise. With the growing popularity of all-inside devices used in this potentially higher-risk population, studies examining the proximity of these devices to neurovascular structures are needed.
Purpose/Hypothesis:
The purpose of this study was to provide distances to neurovascular structures from all-inside devices placed arthroscopically at both high-risk approach angles and zones of the lateral menisci of pediatric cadaveric specimens. It was hypothesized that the neurovascular structures would be situated closely to arthroscopically placed all-inside lateral meniscal devices, particularly the popliteal artery (PA), popliteal vein (PV), and tibial nerve (TN) to devices placed at the posterior root when placed via a lateral portal, as well as the peroneal nerve (PN) to devices placed just medial to the popliteal hiatus via a medial portal.
Study Design:
Descriptive laboratory study.
Methods:
The study involved 12 fresh-frozen cadaveric knee specimens (6 matched pairs) between the ages of 6 and 10. Two all-inside meniscal repair implants were placed in the lateral meniscus: 1 via a medial port just medial to the popliteal hiatus and 1 via a lateral port at the visible edge of the posterior root. Specimens were then dissected posteriorly to expose the posterior knee capsule and meniscal implants. The distance measurements between the implants and the PA, PV, TN, and PN were recorded.
Results:
The distances from the anchors to the PA, PV, TN, and PN ranged from 2.3 to 59.8 mm, 3.5 to 58.0 mm, 5.3 to 63.0 mm, and 6.3 to 40.1 mm, respectively. Implants at the meniscus root were closer to the PA, PV, and TN than implants at the popliteal hiatus (P≤ .001 for all). There was no statistically significant difference in distances to the PN between the 2 implant positions (P = .06).
Conclusion:
This study illustrates the proximity of neurovascular structures to all-inside devices in pediatric knee specimens, particularly those directed at the posterior horn using the anterolateral portal. Under the conditions of this study, all-inside devices appeared to be safe.
Clinical Relevance:
This study provides much-needed data to the growing body of knowledge regarding meniscal injuries and repair in the pediatric population.
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