Assessing the Risk of Injury to the Popliteal Neurovascular Bundle during Lateral Meniscus Repair: A Case Report.
Overview
abstract
INTRODUCTION: The incidence of pediatric meniscal tears and their surgical repair has risen, with complications including iatrogenic injury to the popliteal neurovascular (NV) bundle posing notable risks, particularly during posterior horn lateral meniscus (PHLM) repair. Studies have assessed the PHLM-popliteal NV bundle distance using magnetic resonance imaging (MRI) or cadaveric approaches, but these methods often fail to replicate surgical conditions, such as the knee's figure-of-four position at 90° flexion. CASE REPORT: A 17-year-old male presented with a locked knee at 90° of flexion due to a displaced bucket-handle lateral meniscus tear sustained while wrestling, which was managed with arthroscopic meniscus repair. On preoperative MRI in 90° of flexion, the lateral meniscus posterior capsule to popliteal artery distance measured 15.1 mm. Postoperative MRI with knee in relative extension demonstrated a distance of 5.8 mm. CONCLUSION: The distance between the lateral meniscus posterior capsule and the popliteal NV bundle appears to increase with increasing knee flexion. Thus, the proximity of the NV bundle to the posterior capsule (and therefore the risk of iatrogenic injury during meniscal repair) may be lower than previously reported.
