Abstract
Purpose: Despite a number of recently published reports on the success of meniscal repair devices, there are no anatomic studies documenting their safety. The purpose of this cadaveric and radiographic study was to anatomically determine the proximity of a common commercially available meniscal repair device to the popliteal neurovascular structures
Methods: Five human cadaveric knees were obtained and procured from the medical school anatomy lab. Two Biostingers (Linvatec) measuring 16mm in length were placed in the posterior one third of the medial meniscus. Each specimen was then placed prone with the knee extended to expose the posterior aspect of the knee. The distance to the neurovascular bundle for each device was then measured with a ruler calibrated to the nearest 0.1cm. To validate our anatomic dissection results, fifty calibrated human knee MRI scans were reviewed by two independent radiologists. The distances measured were from the popliteal artery to the closest point at the lateral meniscus periphery/capsule and the medial meniscus periphery/capsule. The average distance as measured by the two radiologists was calculated as was the average for the entire population of fifty subjects
Results: The mean distance in the cadaveric study was 15.6mm (14.0–18.0mm) between the tip of the repair device needle and the neurovascular bundle. The mean distance on MRI from the popliteal neurovascular bundle to the closest point in the posterior medial meniscus was 20.0 mm (13.0 mm–28.7 mm). The mean distance from the popliteal structures to the posterior lateral meniscus was 9.4 mm (3.2 mm–16.5 mm).
Conclusions: Considering the potential for significant morbidity, we recommend medial meniscal repair should be performed carefully with repair devices. Specifically, one should limit posterior capsule penetrations to less than 15 mm based on these findings.
Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
