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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2011

01-04-2011 | Knee

The relationship of neural structures to arthroscopic posterior portals according to knee positioning

Authors: Jin Hwan Ahn, Sang Hak Lee, Ho Joong Jung, Kyung Hyo Koo, Seong Hwan Kim

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2011

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Abstract

Purpose

The purpose of this study was to investigate the relationship between the proximity of neural structures to standard posterior portals in different knee positions.

Methods

Ten fresh cadaveric knees were used to establish the standard posteromedial and posterolateral portals using an outside-in technique with arthroscopic transillumination. The distance from each portal site to the adjacent neurovascular structures (infrapatellar branches of the saphenous nerve) and the sartorial branch of saphenous nerve from the posteromedial portal, and the common peroneal nerve from posterolateral portal was measured using a precision caliper. Distances were recorded with the knees in extension, 45° of flexion and 90° of flexion in order to examine the effect of dynamic knee motion on nerve position.

Results

The mean distance between the posteromedial portal and the superior and inferior branches of infrapatellar branches of the saphenous nerve at full extension was significantly greater than at 90° of flexion. However, there was no difference observed between at 45° and at 90° of flexion. The mean distance from the posteromedial portal to the sartorial branch of saphenous nerve at 90° of flexion was significantly greater (26.1 mm, SD: 4.7) than that at 45° of flexion (18.4 mm, SD: 4.6), and at full extension (14 mm, SD: 4.3) (P < 0.0001). The mean distance between the posterolateral portal to the common peroneal nerve at 90° of flexion was also significantly greater (25.4 mm, SD: 9.2) than that at 45° of flexion (22.5 mm, SD: 8.1), and at full extension (20.1 mm, SD: 9.1) (P < 0.0001).

Conclusion

In this cadaveric study, it shows that position of 90° knee flexion is reasonably safe, in order to establish a posterior portal in knee arthroscopy using the technique described in the current study, especially to avoid the sartorial branch of saphenous nerve and the common peroneal nerve injuries. Results of this study suggest the establishment of posterior portals, while the knee is flexed at an angle of 90° is recommended to ensure the safety of these structures.
Literature
1.
Abram LJ, Froimson AI (1991) Saphenous nerve injury. An unusual arthroscopic complication. Am J Sports Med 19:668–669PubMedCrossRef
2.
Ahn JH, Chung YS, Oh I (2003) Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal. Arthroscopy 19:101–107PubMedCrossRef
3.
Ahn JH, Ha CW (2000) Posterior trans-septal portal for arthroscopic surgery of the knee joint. Arthroscopy 16:774–779PubMedCrossRef
4.
Ahn JH, Wang JH, Yoo JC (2004) Arthroscopic all-inside suture repair of medial meniscus lesion in anterior cruciate ligament–deficient knees: results of second-look arthroscopies in 39 cases. Arthroscopy 20:936–945PubMed
5.
Ahn JH, Yoo JC, Lee SH (2007) Arthroscopic loose-body removal in posterior compartment of the knee joint: a technical note. Knee Surg Sports Traumatol Arthrosc 15:100–106PubMedCrossRef
6.
Amin KB, Cosgarea AJ, Kaeding CC (1999) The value of intercondylar notch visualization of the posteromedial and posterolateral compartments during knee arthroscopy. Arthroscopy 15:813–817PubMedCrossRef
7.
8.
Bennett WF, Sisto D (1995) Arthroscopic lateral portals revisited. A cadaveric study of the safe zones. Am J Orthop (Belle Mead NJ) 24:546–551
9.
Ebraheim NA, Mekhail AO (1997) The infrapatellar branch of the saphenous nerve: an anatomic study. J Orthop Trauma 11:195–199PubMedCrossRef
10.
Figueroa D, Calvo R, Vaisman A, Campero M, Moraga C (2008) Injury to the infrapatellar branch of the saphenous nerve in ACL reconstruction with the hamstrings technique: clinical and electrophysiological study. Knee 15:360–363PubMedCrossRef
11.
Gold DL, Schaner PJ, Sapega AA (1995) The posteromedial portal in knee arthroscopy: an analysis of diagnostic and surgical utility. Arthroscopy 11:139–145PubMedCrossRef
12.
House JH, Ahmed K (1977) Entrapment neuropathy of the infrapatellar branch of the saphenous nerve. Am J Sports Med 5:217–224PubMedCrossRef
13.
Jurist KA, Greene PW III, Shirkhoda A (1989) Peroneal nerve dysfunction as a complication of lateral meniscus repair: a case report and anatomic dissection. Arthroscopy 5:141–147PubMedCrossRef
14.
Kim TK, Savino RM, McFarland EG, Cosgarea AJ (2002) Neurovascular complications of knee arthroscopy. Am J Sports Med 30:619–629PubMed
15.
Krivic A, Stanec S, Zic R, Budi S, Milanovic R, Stanec Z (2003) Lesion of the common peroneal nerve during arthroscopy. Arthroscopy 19:1015–1018PubMedCrossRef
16.
Lubowitz JH, Rossi MJ, Baker BS, Guttmann D (2004) Arthroscopic visualization of the posterior compartments of the knee. Arthroscopy 20:675–680PubMed
17.
Mochida H, Kikuchi S (1995) Injury to infrapatellar branch of saphenous nerve in arthroscopic knee surgery. Clin Orthop Relat Res 320:88–94PubMed
18.
Ogilvie-Harris DJ, Biggs DJ, Mackay M, Weisleder L (1994) Posterior portals for arthroscopic surgery of the knee. Arthroscopy 10:608–613PubMedCrossRef
19.
Ozsoy MH, Tuccar E, Demiryurek D, Bayramoglu A, Hayran M, Cavusoglu AT, Dincel VE, Sakaogullari A (2009) Minimally invasive plating of the distal tibia: do we really sacrifice saphenous vein and nerve? A cadaver study. J Orthop Trauma 23:132–138PubMedCrossRef
20.
Papastergiou SG, Voulgaropoulos H, Mikalef P, Ziogas E, Pappis G, Giannakopoulos I (2006) Injuries to the infrapatellar branch(es) of the saphenous nerve in anterior cruciate ligament reconstruction with four-strand hamstring tendon autograft: vertical versus horizontal incision for harvest. Knee Surg Sports Traumatol Arthrosc 14:789–793PubMedCrossRef
21.
Peicha G, Pascher A, Schwarzl F, Pierer G, Fellinger M, Passler JM (1998) Transsection of the peroneal nerve complicating knee arthroscopy: case report and cadaver study. Arthroscopy 14:221–223PubMedCrossRef
22.
Pinar H, Ozkan M, Akseki D, Yorukoglu K (1996) Traumatic prepatellar neuroma: an unusual cause of anterior knee pain. Knee Surg Sports Traumatol Arthrosc 4:154–156PubMedCrossRef
23.
Portland GH, Martin D, Keene G, Menz T (2005) Injury to the infrapatellar branch of the saphenous nerve in anterior cruciate ligament reconstruction: comparison of horizontal versus vertical harvest site incisions. Arthroscopy 21:281–285PubMedCrossRef
24.
Rodeo SA, Forster RA, Weiland AJ (1993) Neurological complications due to arthroscopy. J Bone Joint Surg Am 75:917–926PubMed
25.
Sanders B, Rolf R, McClelland W, Xerogeanes J (2007) Prevalence of saphenous nerve injury after autogenous hamstring harvest: an anatomic and clinical study of sartorial branch injury. Arthroscopy 23:956–963PubMedCrossRef
26.
Small NC (1988) Complications in arthroscopic surgery performed by experienced arthroscopists. Arthroscopy 4:215–221PubMedCrossRef
27.
Swanson AJ (1983) The incidence of prepatellar neuropathy following medial meniscectomy. Clin Orthop Relat Res 181:151–153PubMed
28.
Tennent TD, Birch NC, Holmes MJ, Birch R, Goddard NJ (1998) Knee pain and the infrapatellar branch of the saphenous nerve. J R Soc Med 91:573–575PubMed
29.
Tifford CD, Spero L, Luke T, Plancher KD (2000) The relationship of the infrapatellar branches of the saphenous nerve to arthroscopy portals and incisions for anterior cruciate ligament surgery. An anatomic study. Am J Sports Med 28:562–567PubMed
30.
Wijdicks CA, Westerhaus BD, Brand EJ, Johansen S, Engebretsen L, LaPrade RF (2010) Sartorial branch of the saphenous nerve in relation to a medial knee ligament repair or reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1105–1109PubMedCrossRef
Metadata
Title
The relationship of neural structures to arthroscopic posterior portals according to knee positioning
Authors
Jin Hwan Ahn
Sang Hak Lee
Ho Joong Jung
Kyung Hyo Koo
Seong Hwan Kim
Publication date
01-04-2011
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2011
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-010-1326-7

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