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. 2021 Dec:33:159-168.
doi: 10.1016/j.knee.2021.09.004. Epub 2021 Oct 6.

Deep flexion helps to avoid popliteal artery injury during all-inside lateral meniscal repair: A cadaveric study

Affiliations

Deep flexion helps to avoid popliteal artery injury during all-inside lateral meniscal repair: A cadaveric study

Takafumi Mizuno et al. Knee. 2021 Dec.

Abstract

Background: Arthroscopic meniscus repair rarely leads to major complications such as popliteal artery injury. The distance between the suturing device and the popliteal artery, and the risk of popliteal artery injury at different knee flexion angles during all-inside lateral meniscal repair remain unclear.

Methods: All-inside devices were inserted into 10 human cadaveric knees at the posterior horn of the lateral meniscus through the anterolateral portal at 60°, 90°, and 120° knee flexion; posterior segment of the lateral meniscus through the anterolateral portal at 60°, 90°, and 120°; and anteromedial portal at 90°. Distance and positional relationship between the device and popliteal artery were measured radiographically.

Results: In posterior horn repair through the anterolateral portal, the median distance increased from 5.7 mm at 60° to 9.1 mm at 90° (P = 0.63) and 18.0 mm at 120° (P = 0.02). The device pushed the wire at 60° in three cases, 90° in one case, and 120° in 0 cases. In posterior segment repair through the anterolateral portal, the median distance was 12.6 mm at 60°, 10.4 mm at 90°, and 18.3 mm at 120° (P = 0.08). The median distance at 90° was 18.1 mm through the anteromedial portal, the same as that at 120° through the anterolateral portal (P = 0.43), but greater than that at 90° through the anterolateral portal (P = 0.04). The wire was not pushed in any case.

Conclusion: Although all-inside repair of the posterior part of the lateral meniscus through the anterolateral portal is risky, deeper knee flexion reduces the risk of popliteal artery injury.

Keywords: Anatomy; Arthroscopy; Cadaver; Knee; Knee flexion; Meniscus; Popliteal artery injury.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: T.M. reports non-financial support from Smith & Nephew during the study. H.H. reports non-financial support from Smith & Nephew during the study as well as personal fees from Johnson & Johnson K.K., personal fees from Stryker Japan K.K., and personal fees from Smith & Nephew K.K. outside the submitted work. T.T. reports non-financial support from Smith & Nephew during the study. S. Ishizuka has nothing to disclose. S.Y. has nothing to disclose. T.S. reports non-financial support from Smith & Nephew during the study as well as grants from Stryker Japan K.K., grants from Zimmer Biomet G.K., grants from Smith & Nephew K.K., and grants from Meira Corporation outside the submitted work. S. Imagama has nothing to disclose.

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