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No risk of iatrogenic peroneal nerve injury in all-inside lateral meniscal repair with either 14- or 18-mm needles through the popliteus tendon in the standard arthroscopic knee conditions

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope



The objectives of this prospective study were to evaluate the risk of peroneal nerve (PN) injury in simulated all-inside lateral meniscal repair with sutures placed through the popliteus tendon (PT) and to determine the optimal needle length.


Twenty-nine axial magnetic resonance images (MRI) of postoperative knees with infused intra-articular fluid and in a figure-of-four position were used. The cross-sectional length of the PT was divided into four equal parts with measurements performed at the 25%, 50% and 75% points according to their anteroposterior arrangement. Simulated repairs were performed with 14-mm and 18-mm straight needles via the anteromedial (AM) and anterolateral (AL) portals. Distances from the needle tip following full insertion through the PT to the PN and from the anterior PT border to the posterior knee capsule were measured to determine PN injury risk and ideal needle insertion depths at the different landmarks.


Simulated repairs on the 29 knee MRI images resulted in no incidences of PN injury. The average distances from the needle tip to the PN of the 14-mm needle were significantly greater than the 18-mm needle in all the simulated repairs (P < 0.02), except at the 25% point in the AM approach. When using the 14-mm needle, capsule underpenetration was found in three knees (10.3%) at the 25% point during the AM approach, in one knee (3.4%) at the 50% and 75% points in the AM approach, and in all repairs from the AL portal. The average distances from the anterior PT border to the capsule at the 25%, 50%, and 75% division points on the PT in the AM approach were 7.7 ± 2.7 mm, 7.9 ± 2.5 mm and 7.6 ± 2.8 mm, respectively, whilst in the AL approach were 8.4 ± 2.9 mm, 8.1 ± 2.8 mm and 7.6 ± 2.7 mm.


Simulated all-inside lateral meniscal repair with suture placement through the PT with 14-mm and 18-mm needles was safe. The measurements in this study can be used to determine potential PN injury risk in relation to the PT and the appropriate needle length for safe lateral meniscal repairs.

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The authors sincerely thank Dr Boonsin Tangtrakulwanich of the Department of Orthopedics for his suggestion concerning studying the safety knowledge gap in lateral meniscal repairs; Nannapat Pruphetkaew of the Epidemiology Unit, Faculty of Medicine of Prince of Songkla University for providing statistical support; Konwarat Ninlachart for assistance with the demonstration drawings; and Dave Patterson for his editing support.


Funding for this project was provided by the Faculty of Medicine of Prince of Songkla University.

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PA and CC: conceived and designed the analysis. TB and WP: collected the data. CC and PB: performed the analysis. PA: wrote the paper. All authors read and approved the final manuscript.

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Correspondence to Chaiwat Chuaychoosakoon.

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The study was approved by the Ethics Committee of the Faculty of Medicine of Prince of Songkla University (REC 60-180-11-1, 64-607-11-1).

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All patients gave informed consent before being included in this study.

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Asavanapakas, P., Boonsri, P., Parinyakhup, W. et al. No risk of iatrogenic peroneal nerve injury in all-inside lateral meniscal repair with either 14- or 18-mm needles through the popliteus tendon in the standard arthroscopic knee conditions. Knee Surg Sports Traumatol Arthrosc 31, 2331–2337 (2023).

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