The Position of the Popliteal Artery and Peroneal Nerve Relative to the Menisci in Children: A Cadaveric Study

Abstract

Background: Meniscal injury in skeletally immature patients is increasingly reported. During meniscal repair, all-inside devices may protrude beyond the posterior limits of the meniscus, putting the neurovascular structures at risk. Purpose: The purposes of this study were (1) to examine the relationship between the popliteal artery and the posterolateral and posteromedial aspects of the menisci, (2) to examine the relationship of the peroneal nerve to the posterolateral meniscus, and (3) to develop recommendations for avoiding neurovascular injury during posterior meniscal repair in pediatric patients. Study Design: Descriptive laboratory study. Methods: A total of 26 skeletally immature knee cadaveric specimens (7 females and 19 males) were included. Specimens were divided into age groups: 2-4, 5-8, and 9-11 years. The most posterior extent of the lateral and medial menisci was identified via sagittal and axial views on computed tomography (CT) scans. The shortest distance from the most posterior aspect of the lateral and medial menisci to the popliteal artery and the shortest distance from the posterior aspect of the lateral menisci to the anterior rim of the peroneal nerve were measured, and 3-dimensional models of representative specimens were re-created through use of CT scans. Results: For the age groups 2-4, 5-8, and 9-11 years, the mean minimum distance from the posterolateral meniscus to the popliteal artery was 5.2, 6.7, and 8.2 mm, respectively, and the mean minimum distance from the posteromedial meniscus to the popliteal artery was 12.7, 15.4, and 20.3 mm, respectively. In all groups, the distance between the posteromedial meniscus and the popliteal artery was greater than that between the posterolateral meniscus and the popliteal artery. The mean distance from the peroneal nerve to the lateral meniscus was 13.3, 15.0, and 17.9 mm for the respective groups. Conclusion: Many all-inside meniscal repair devices have sharp tips that penetrate posterior to the meniscus and capsule. This study demonstrated that the distance between the posterior meniscus and popliteal artery is relatively small in pediatric patients, especially for the lateral meniscus region. Clinical Relevance: Because of the higher potential for meniscal healing, meniscal repair is more likely to be performed in pediatric patients. The data in this study regarding the proximity of the lateral meniscus and neurovascular structures may be used to guide safe surgical repair of posterior meniscal tears during the use of all-inside meniscal repair devices in these patients.