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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Joint Line Obliquity Can Increase Meniscus Root Tension ePoster Presentation Shuntaro Nejima, MD, PhD, JAPAN Andy Williams, MBBS, FRCS(Orth), FFSEM(UK), UNITED KINGDOM Andrew A. Amis, FREng, DSc, PhD, UNITED KINGDOM
Relationship Between Patient-Reported Outcome Measures (Proms) And Mri Abnormalities In Early Knee Osteoarthritis ePoster Presentation Kentaro Fujita, MD, JAPAN Yasushi Takata, MD, PhD, JAPAN Tomoyuki Kanayama, MD, JAPAN Yoshihiro Ishida, MD, JAPAN Naoki Takemoto, MD, JAPAN Manase Nishimura, MD, JAPAN Takuya Sengoku, PT, PhD, JAPAN Yushin Mizuno, MSc, PT, JAPAN Junsuke Nakase, MD, PhD, JAPAN
Detailed Anatomy of the Meniscotibial Ligament and Clock Face Position of Meniscal Attachments in the Tibia ePoster Presentation Keiichi Yoshida, MD, PhD, JAPAN Youngji Kim, MD, PhD, JAPAN Haruka Kaneko, JAPAN Yoshitomo Saita, MD, PhD, JAPAN Mitsuaki Kubota, MD, PhD, JAPAN Muneaki Ishijima, MD, PhD, JAPAN
Magnetic Resonance Imaging Findings of the Medial Meniscus in Early-stage Osteoarthritis of the Knee ePoster Presentation Yasushi Takata, MD, PhD, JAPAN Junsuke Nakase, MD, PhD, JAPAN Yoshihiro Ishida, MD, JAPAN Naoki Takemoto, MD, JAPAN Manase Nishimura, MD, JAPAN Takuya Sengoku, PT, PhD, JAPAN Yushin Mizuno, MSc, PT, JAPAN
Biomechanical Effect Of Location And Number Of Bone Tunnels In Transtibial Pull-Out Repair For Medial Meniscus Posterior Root Tear ePoster Presentation Toshitaka Tsunematsu, MD, JAPAN Tomoki Ohori, MD, PhD, JAPAN Akira Tsujii, MD, PhD, JAPAN Shuto Yamashita, MD, JAPAN Ayaka Tanaka, MD, JAPAN Shunya Otani, MD, PhD, JAPAN Seira Sato, MD, PhD, JAPAN Ken Nakata, MD, PhD, JAPAN Seiji Okada, MD, PhD, Prof., JAPAN
Long-Term Structural and Functional Outcomes Following Meniscal Allograft Transplantation ePoster Presentation Deidre López Guardiola, MD, MEXICO Francisco Cruz López, MD, MEXICO
Similar Re-Rupture Rates After Lateral Posterior Root Rupture Repairs With Or Without Separate Tunnels ePoster Presentation Björn Barenius, MD, PhD, ass. Prof., SWEDEN Christoffer von Essen, MD, PhD, SWEDEN

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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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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

More 2025 ISAKOS Congress Content