ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #1021

 

Avoiding Damage to the Popliteal Neurovascular Bundle in All-Inside Suturing of the Posterior Horn of the Lateral Meniscus: An MRI Assessment of Portal Selection and Safety

Ron Gilat, MD, Tel Aviv ISRAEL
Yiftah Beer, MD, Shoham ISRAEL
Gabriel Agar, MD, Tel Aviv ISRAEL
Dror Lindner, MD, Savyon ISRAEL

Assaf Harofeh Medical Center, Tzrifin, ISRAEL

FDA Status Not Applicable

Summary

All-Inside suturing of the PHLM carries a risk for a rare, however, possibly devastating injury to the popliteal NVB. Our study suggests that suturing of the PHLM at 0mm from the PCL is safer using a more lateral portal, while, beyond 3mm from the PCL a more medial portal is safer. Preoperative MRI planning of portal selection and safety may decrease the risk for damage to the popliteal NVB.

Abstract

Purpose

All-Inside suturing of the posterior horn of the lateral meniscus (PHLM) carries a risk for a rare, however, possibly devastating injury to the popliteal neurovascular bundle (NVB). The purpose of this study is to assess the risk of damage to the popliteal NVB while suturing the PHLM.

Methods

We simulated all-inside suturing of the PHLM using axial plane cross section magnetic resonance imaging (MRI) of the knees of 60 consecutive patients. Lines were drawn from conventional anteromedial and anterolateral portals to the PHLM at increasing distance from the posterior cruciate ligament (0mm, 3mm, 6mm, 9mm and 12mm), to simulate all-inside suturing device trajectory. Distance from each of these lines to the popliteal NVB was measured. Additional similar analysis was performed for portals 1cm-medial and 1 cm-lateral to the conventional portals.

Results

Average distance of the popliteal NVB to the PHLM was 7.8mm. Out of the 1200 measurements performed, the simulated suturing trajectory transected the popliteal NVB a total of 343 times (28.6%). At 0mm from the posterior cruciate ligament (PCL) the safest portal was the 1cm-lateral portal (p<0.008) with average distance of 2.7mm to the popliteal NVB. At 3mm, 6mm, 9mm and 12mm from the PCL the safest portal was the 1cm-Medial portal (p<0.007) with average distances to the popliteal NVB of 3.8mm, 6.9mm, 10.1mm and 13.5mm, respectively.

Conclusions

All-inside suturing of the PHLM at 0mm from the PCL is safer using a more lateral portal, while, beyond 3mm from the PCL a more medial portal is the safer option. Focused preoperative MRI assessment and planning of portal selection and safety may decrease the risk for damage to the popliteal NVB with all-inside suturing of the PHLM.