Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
J Bone Joint Surg Am. 2024 Apr 3;106(7):617-624. doi: 10.2106/JBJS.23.00749. Epub 2024 Feb 21.
Various studies have examined the risk of peroneal nerve injury with use of standard magnetic resonance imaging (MRI) of the knee. However, the position of the knee during standard MRI is different from that during an actual arthroscopic lateral meniscal repair. The purpose of the present study was to evaluate and compare the risk of peroneal nerve injury during simulated all-inside lateral meniscal repairs on the basis of MRI scans made with the knee in both positions.
With use of axial MRI scans made with the knee in the standard position (i.e., in 30° of flexion) and in the actual position used during arthroscopic lateral meniscal repair (i.e., in a figure-of-4 position), direct lines were drawn to simulate the passage of a straight all-inside meniscal repair device from the anteromedial and anterolateral portals to the medial and lateral borders of the popliteus tendon. The distance from the closest passage of each line to the peroneal nerve was measured. If a line touched or passed through the peroneal nerve, a risk of iatrogenic injury was noted and a new line was drawn from the same portal to the outer border of the peroneal nerve. The danger area was measured from the first line to the new line along the joint capsule.
In 28 Thai patients, the shortest distances from each line to the peroneal nerve were significantly shorter on the MRI scans made with the knee in the standard position than on those made with the knee in the arthroscopic position (p < 0.05 for all). All danger areas on the MRI scans that were made with the knee in the arthroscopic position were included within the danger areas on the scans that were made with the knee in the standard position.
Standard MRI scans of the knee can be used to determine the risk of peroneal nerve injury at the time of arthroscopic lateral meniscal repair, although the risks are slightly overestimated.
Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
多项研究已经对使用标准膝关节磁共振成像（MRI）检查时腓总神经损伤的风险进行了研究。然而，标准 MRI 检查时膝关节的位置与实际关节镜下外侧半月板修复时的位置不同。本研究的目的是基于 MRI 扫描，评估并比较膝关节在标准位置（即 30°屈曲）和关节镜下外侧半月板修复时实际位置（即“8”字形位置）下进行模拟全内入路外侧半月板修复时腓总神经损伤的风险。
使用标准位置（即 30°屈曲）和关节镜下外侧半月板修复时实际位置（即“8”字形位置）的轴向 MRI 扫描，绘制模拟从前内侧和前外侧入路到腘肌腱内外侧缘的直式全内入路半月板修复器械的直线。测量每条线与腓总神经最近通过点的距离。如果一条线触及或穿过腓总神经，则记录为医源性损伤风险，并从同一入路向腓总神经的外缘重新绘制一条线。从第一条线到新线沿着关节囊测量危险区域。
在 28 例泰国患者中，标准 MRI 扫描时每条线到腓总神经的最短距离明显短于关节镜 MRI 扫描（所有测量值均为 p < 0.05）。关节镜 MRI 扫描时所有的危险区域都包含在标准 MRI 扫描时的危险区域内。
标准膝关节 MRI 扫描可用于确定关节镜下外侧半月板修复时腓总神经损伤的风险，尽管风险略有高估。
诊断 III 级。请参阅作者说明以获取完整的证据水平描述。
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