Proximity of the neurovascular structures during all-inside lateral meniscal repair in children: a cadaveric study

Yi-Meng Yen,Henry B Ellis,Peter D Fabricant,Aleksei B Dingel,Theodore J Ganley,Kevin G Shea,Matthew D Milewski,Connor G Richmond,Stephanie W Mayer,Philip L Wilson

doi:10.1186/s40634-018-0166-0

Abstract

PurposeMeniscal repair has become increasingly common in a pediatric and adolescent population. All-inside repair techniques are utilized more often given their ease of insertion and decreased operative time required. However, there are possible risks including damage to adjacent neurovascular structures. The purpose of this study to was examine the proximity of the neurovascular structures during lateral meniscus repairs in pediatric specimens simulating a worst-case scenario.MethodsTen pediatric cadaveric knees (age 4–11) were utilized and simulated lateral meniscal repair through the posterior horn of the lateral meniscus and both medial and lateral to the popliteal hiatus through the body of the lateral meniscus was performed with an all-inside meniscal repair device. The distance to the popliteal artery or peroneal nerve was measured.ResultsDuring posterior horn repair, the average distance from the all-inside device to the popliteal artery was 1.9 mm ± 1.1 mm. There was penetration of the artery in one specimen. During repair on the medial side of popliteal hiatus, the average distance from the all-inside device to the peroneal nerve was 3.2 mm ± 2.0 mm. During repair on the lateral side of popliteal hiatus, the average distance from the all-inside device to the peroneal nerve was 12.4 mm ± 3.7 mm.ConclusionsThis study demonstrates that the proximity of the neurovascular structures to the lateral meniscus in children is extremely close and at high risk during meniscal repair with all-inside devices. This study gives important data for the proximity of these structures during these repair techniques.Level of evidenceLevel 5 Cadaveric Study.

Highlights

This study demonstrates that the proximity of the neurovascular structures to the lateral meniscus in children is extremely close and at high risk during meniscal repair with all-inside devices
In the pediatric and adolescent population, meniscal injuries are rising in incidence, in part due to increased athletic participation, expanded use of magnetic resonance imaging and improved recognition and diagnosis (Bellisari et al, 2011; Brown & Davis, 2006; Francavilla et al, 2014)
The inside-out meniscal repair remains the gold standard for meniscal fixation, but can be associated with an increased surgical time and the need for an additional posterolateral or posteromedial incision (Lembach & Johnson, 2014; Woodmass et al, 2017)

Summary

Introduction

In the pediatric and adolescent population, meniscal injuries are rising in incidence, in part due to increased athletic participation, expanded use of magnetic resonance imaging and improved recognition and diagnosis (Bellisari et al, 2011; Brown & Davis, 2006; Francavilla et al, 2014). The menisci play a critical role in shock absorption, reduction of femoro-tibial contact forces and as secondary stabilizers within the knee joint. Partial or total menisectomies can lead to early joint degeneration and resultant osteoarthritis (Lanzer & Komenda, 1990; McDermott & Amis, 2006; Shoemaker & Markolf, 1986). The trend has been towards repair of meniscal tears, in the pediatric and adolescent athlete. The inside-out meniscal repair remains the gold standard for meniscal fixation, but can be associated with an increased surgical time and the need for an additional posterolateral or posteromedial incision (Lembach & Johnson, 2014; Woodmass et al, 2017).

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