New research has mapped the iatrogenic neurovascular injury danger zone in lateral meniscal repair and found that it can be minimized by avoiding an all-inside meniscal device.
Where is the Neurovascular Danger Zone for Meniscal Repair?
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Secondary#allinsidemeniscalrepair#iatrogenicneurovascularyinjury
In the study, “The Danger Zone for Iatrogenic Neurovascular Injury In All-Inside Lateral Meniscal Repair in Relation to the Popliteal Tendon: An MRI Study,” which was published online on October 4, 2021 in Orthopaedic Journal of Sports Medicine, the researchers explore the danger zone of all-inside meniscal repair.
“Lateral meniscal repair can endanger the nearby neurovascular structure (peroneal nerve or popliteal artery). To our knowledge, there have been no studies to evaluate the danger zone of all-inside meniscal repair through the anteromedial (AM) and anterolateral (AL) portals in relation to the medial and lateral edges of the popliteal tendon,” they wrote.
The researchers wanted to establish the risk of neurovascular injury and the danger zone in repairing the lateral meniscus in relation to the medial and lateral edges of the popliteal tendon.
They used axial magnetic resonance imaging to simulate the straight, all-inside meniscal repair device, drawn from the anteromedial and anterolateral portals to both the medial and lateral edges of the popliteal tendon. If a line passed through the neurovascular structure, than a risk of iatragenic neurovascular injury was determined high.
Two hundred and forty adult patients were included in the study. Through the axial MRI images, the researchers found that repairing the body of the lateral meniscus through the anteromedial portal had a greater risk of neurovascular injury than repairs made through anterolateral portal in relation to the medial edge of the popliteal tendon (p = .006).
The danger zone in repairing the lateral meniscus through the anteromedial portal extended 1.82 ±1.68 mm laterally from the lateral edge of the popliteal tendon and 3.13 ± 2.45 mm medially from the medial edge of the popliteal tendon.
Through the anterolateral portal, the danger zone extended 2.81 ±1.94 mm laterally from the lateral edge of the popliteal tendon and 1.39 ±1.53 mm medially from the medial edge of the popliteal tendon.
“Repairing the lateral meniscus through either the anteromedial or anterolateral portals in relation to the popliteal tendon can endanger the peroneal nerve or popliteal artery,” they wrote.
“The surgeon can minimize the risk of iatrogenic neurovascular injury in lateral meniscal repair by avoiding using the all-inside meniscal device in the danger zone area as described in this study.”
The researchers who conducted the study were: Chaiwat Chuaychoosakoon, M.D.; Watit Wuttimanop, M.D.; Preyanun Tangjatsakow, M.D.; Sasathron Charoenrattatanawat, M.D.; and Tanarat Boonriong, M.D., of Prince of Songkla University in Songkhla; Thailand. Bancha Chernchujt, M.D., of Thammasat University in Pathumthani; Thailand was on the research team as well.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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