Summary: Standard MRI scans of the knee cannot be safely used to determine the risk of iatrogenic neurovascular injury in arthroscopic medial meniscal repair.

Background

Various studies have examined the risk of neurovascular injury using standard magnetic resonance images (MRIs) of the knee. However, the condition of the knee during a standard MRI with 30-degree of knee flexion is different from that during an actual arthroscopic medial meniscal repair with slight knee flexion, valgus force and joint fluid dilatation. The purpose of the present study was to evaluate and compare the risk of posterior neurovascular and saphenous nerve injury during simulated all-inside medial meniscal repairs on the basis of MRI scans made with knees in 30 degrees of flexion and actual arthroscopic positions.

Methods

The study used axial MRI scans made with knees in the standard position (i.e., with 30 degrees of knee flexion) and in the actual position used during arthroscopic medial meniscal repair (i.e., slight knee flexion with valgus force and joint fluid dilatation). An anterolateral portal was set at the lateral border of the patellar tendon and anteromedial and accessory anteromedial portals were set at the medial border and 10 mm from the medial border of the patellar tendon. Direct lines were drawn to simulate the passage of a straight all-inside meniscal repair device from the three portals to the medial border of the posterior medial meniscal root (pMMR). If a line touched or passed through the posterior neurovascular structure or saphenous nerve, a risk of iatrogenic injury was noted and a second line was drawn from the same portal to the outer border of the neurovascular structure. The danger area was measured from the first line to the second line along the meniscocapsular capsule.

Results

There was a risk of posterior neurovascular injury in medial meniscal repairs through the accessory anteromedial and anteromedial portals related to the medial border of the pMMR, and there was a risk of saphenous nerve injury in repairs through all portals. The risk in arthroscopic position MRIs was higher than standard MRIs. The danger zones indicating the risk of saphenous nerve injury in medial meniscal repair through the anterolateral, anteromedial and accessory anteromedial portals using arthroscopic position and standard MRIs were 15.29 ± 7.39, 28.12 ± 6.23 and 31.47 ± 6.69 mm, respectively, and 15.99 ± 7.37, 28.00 ± 6.86 and 30.96 ± 6.68 mm, respectively, beyond the medial border of the pMMR along the meniscocapsular capsule. There were no statistically significant differences in the danger zones between standard and arthroscopic position MRIs (p <0.05 for all) but some danger zones from the arthroscopic MRIs were not indicated in the standard MRIs.

Conclusions

Standard MRI scans of the knee cannot be safely used to determine the risk of iatrogenic neurovascular injury in arthroscopic medial meniscal repair. In clinical practice, surgeons can use the danger zones identified in the arthroscopic MRIs from this study to reduce the risk of iatrogenic neurovascular injury. However, the surgeon cannot be use standard knee MRI to determine danger zones in arthroscopic medial meniscal repair because some danger areas identified in the arthroscopic MRIs were not present in the standard MRIs.

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Contralateral Synovial Fluid Biomarkers Predict 10-Year Patient-Reported Outcomes Of Arthroscopic Partial Meniscectomy ePoster Presentation Vishal Sundaram, BA, UNITED STATES Emily Berzolla, BS, UNITED STATES Michael Moore, BA, UNITED STATES Nathaniel P. Mercer, MD, UNITED STATES Bradley Austin Lezak, MD, MPH, UNITED STATES Heath Patrick Gould, MD, UNITED STATES Daniel James Kaplan, MD, UNITED STATES Eric Strauss, UNITED STATES
The Impact Of BMI And Concomitant Knee Pathology On Medial And Lateral Meniscus Tear Complexity In The Pediatric Population ePoster Presentation Kristen N. Reikersdorfer, BA, UNITED STATES Serafina Faith Zotter, BS, UNITED STATES Nikolaos K. Paschos, MD, PhD, UNITED STATES
Failure And Complication Rates Following Meniscal All-Inside And Inside-Out Repairs: A Meta-Analysis ePoster Presentation Juan Bernardo Villarreal-Espinosa, MD, UNITED STATES Rodrigo Saad Berreta, BA, UNITED STATES Lucas Pallone, MD, BRAZIL Felicitas Allende Figueroa, MD, ARGENTINA Fernando Gómez Verdejo, MD, MEXICO Zeeshan Khan, BA, UNITED STATES Melissa Carpenter, MD, UNITED STATES Sachin Allahabadi, MD, UNITED STATES Jorge Chahla, MD, PhD, UNITED STATES
Knee Injury Detection Using Unsupervised Machine Learning Model ePoster Presentation Gonzalo F. Ferrer, MD, CHILE Francisco Jose Gonzalez Rojas, MD, CHILE Ignacio Andres Muñoz Eichler, Lic, CHILE Alejandro Orizola, CHILE Fernando Radice, MD, CHILE
A Novel Method for Evaluating the Effect of a Lateral Meniscus Posterior Root Tear on the Loaded Mechanics of a Human Cadaveric Knee’s Lateral Compartment ePoster Presentation Edward Hoptioncann, BASc, CANADA Jordan Broberg, PhD, CANADA Parth Lodhia, MD, FRCSC, CANADA David R. Wilson, DPhil, CANADA Andrew Yung, MASc, CANADA Kirsten Bale, BSc, CANADA
No Significant Difference In Meniscus Root Repair Failure Rates Or Patient Reported Outcomes For Patients Greater Than 60-Years-Old. ePoster Presentation Alexandra Stevens, BS, UNITED STATES Robert A. Magnussen, MD, MPH, UNITED STATES Christopher C. Kaeding, MD, UNITED STATES Eric Milliron, BS, UNITED STATES Parker Cavendish, BS, UNITED STATES Tyler Barker, PhD, UNITED STATES Noah Mallory, BE, UNITED STATES James C. Kirven, BS, UNITED STATES David C. Flanigan, MD, UNITED STATES

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Assessing the Risk of Iatrogenic Neurovascular Injury in All-Inside Medial Meniscal Repair Between Standard Versus Arthroscopic MRIs

Assessing the Risk of Iatrogenic Neurovascular Injury in All-Inside Medial Meniscal Repair Between Standard Versus Arthroscopic MRIs

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Methods

Results

Conclusions

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Assessing the Risk of Iatrogenic Neurovascular Injury in All-Inside Medial Meniscal Repair Between Standard Versus Arthroscopic MRIs

Assessing the Risk of Iatrogenic Neurovascular Injury in All-Inside Medial Meniscal Repair Between Standard Versus Arthroscopic MRIs

Background

Methods

Results

Conclusions