Abstract
Purpose
The aims of this study were as follows: (1) to determine the dimensions of the posterior compartments and the location of the popliteal artery with regard to the posterior septum by magnetic resonance arthrography; (2) to assess the effect of demographic factors on the measurements taken; and (3) to find a safe means of establishing the transseptal portal.
Methods
Thirty magnetic resonance arthrographies taken in 90° of flexion were evaluated to simulate knee position during arthroscopic surgery. Coronal and axial images were obtained in positions parallel and perpendicular to the long axis of the tibia, respectively. The anterior-to-posterior dimensions of the posteromedial and posterolateral compartments and popliteal artery locations were measured in the safe zone to establish transseptal portals. These dimensions were measured in axial images corresponding to the mid-PCL level.
Results
The average anterior-to-posterior dimension was 11.7 ± 2.9 mm in the posteromedial compartment versus 7.9 ± 1.8 mm in the posterolateral compartment. The anterior-to-posterior dimension was consistently greater in the posteromedial compartment, and the average ratio of the two dimensions was 1.5 ± 0.3. The average posterior deviation of the popliteal artery from the PCL was 27.1 ± 4.8 mm. The popliteal artery was always located lateral to the septum, and the lateral deviation on averaged measured 10.2 ± 4.0 mm.
Conclusions
The safe margin of the posteromedial compartment is consistently wider than that of the posterolateral compartment, and the popliteal artery is consistently located lateral to the posterior septum. Therefore, injury to the popliteal artery can be avoided when penetrating the septum lateral to medial direction, even if the penetrating stick slips posteriorly.
Level of evidence
Diagnostic study, Level IV.
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References
Ahn JH, Chung YS, Oh I (2003) Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal. Arthroscopy 19:101–107
Ahn JH, Ha CW (2000) Posterior trans-septal portal for arthroscopic surgery of the knee joint. Arthroscopy 16:774–779
Ahn JH, Lee SH, Jung HJ, Koo KH, Kim SH (2010) The relationship of neural structures to arthroscopic posterior portals according to knee positioning. Knee Surg Sports Traumatol Arthrosc doi:10.1007/s00167-010-1326-7
Beck DE, Robison JG, Hallett JW Jr (1986) Popliteal artery pseudoaneurysm following arthroscopy. J Trauma 26:87–89
Bernard M, Grothues-Spork M, Georgoulis A, Hertel P (1994) Neural and vascular complications of arthroscopic meniscal surgery. Knee Surg Sports Traumatol Arthrosc 2:14–18
Cosgarea AJ, Kramer DE, Bahk MS, Totty WG, Matava MJ (2006) Proximity of the popliteal artery to the PCL during simulated knee arthroscopy: implications for establishing the posterior trans-septal portal. J Knee Surg 19:181–185
Furie E, Yerys P, Cutcliffe D, Febre E (1995) Risk factors for arthroscopic popliteal artery laceration. Arthroscopy 11:324–327
Jeffries JT, Gainor BJ, Allen WC, Cikrit D (1987) Injury to the popliteal artery as a complication of arthroscopic surgery. A report of two cases. J Bone Joint Surg Am 69:783–785
Jimenez F, Utrilla A, Cuesta C, Cobo G, AC L, Egana JM, Gandarias C (1988) Popliteal artery and venous aneurysm as a complication of arthroscopic meniscectomy. J Trauma 28:1404–1405
Kim J-M (1997) Direct posterior-posterior triangulation of the knee joint. Arthroscopy 13:262–264
Kim J, Shin D, Dan J, Nam K, Ahn T, Lee D (2009) Arthroscopic suture anchor repair of posterior root attachment injury in medial meniscus: technical note. Arch Orthop Trauma Surg 129:1085–1088
Kim SJ, Jung KA, Kwun JD, Kim JM (2006) Arthroscopic synovectomy of the knee joint in rheumatoid arthritis: surgical steps for complete synovectomy. Arthroscopy 22:461.e1–461.e4
Kim SJ, Kim HJ (2001) High portal: Practical philosophy for positioning portals in knee arthroscopy. Arthroscopy 17:333–337
Kim SJ, Shin SJ, Choi NH, Cho SK (2001) Arthroscopically assisted treatment of avulsion fractures of the posterior cruciate ligament from the tibia. J Bone Joint Surg Am 83-A:698–708
Louisia S, Charrois O, Beaufils P (2003) Posterior “back and forth” approach in arthroscopic surgery on the posterior knee compartments. Arthroscopy 19:321–325
Mariani PP (2010) Arthroscopic release of the posterior compartments in the treatment of extension deficit of knee. Knee Surg Sports Traumatol Arthrosc 18:736–741
Matava MJ, Sethi NS, Totty WG (2000) Proximity of the posterior cruciate ligament insertion to the popliteal artery as a function of the knee flexion angle: implications for posterior cruciate ligament reconstruction. Arthroscopy 16:796–804
Ninomiya JT, Dean JC, Goldberg VM (1999) Injury to the popliteal artery and its anatomic location in total knee arthroplasty. J Arthroplasty 14:803–809
Potter D, Morris-Jones W (1995) Popliteal artery injury complicating arthroscopic meniscectomy. Arthroscopy 11:723–726
Ritt MJ, Te Slaa RL, Koning J, Bruijn JD (1993) Popliteal pseudoaneurysm after arthroscopic meniscectomy. A report of two cases. Clin Orthop Relat Res 295:198–200
Tawes RL Jr, Etheredge SN, Webb RL, Enloe LJ, Stallone RJ (1988) Popliteal artery injury complicating arthroscopic menisectomy. Am J Surg 156:136–138
Acknowledgments
The authors thank Mr. Dong-Su Jang, Research Assistant, Department of Anatomy, Yonsei University College of Medicine, Seoul, for his help with the figures.
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Kim, SJ., Song, HT., Moon, HK. et al. The safe establishment of a transseptal portal in the posterior knee. Knee Surg Sports Traumatol Arthrosc 19, 1320–1325 (2011). https://doi.org/10.1007/s00167-011-1429-9
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DOI: https://doi.org/10.1007/s00167-011-1429-9