{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:39:22Z","timestamp":1783489162151,"version":"3.55.0"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,7,17]],"date-time":"2018-07-17T00:00:00Z","timestamp":1531785600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,7,17]],"date-time":"2018-07-17T00:00:00Z","timestamp":1531785600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2019,1,30]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>There is a theoretical risk of injury to neurovascular structures during inside\u2010out meniscal repair without a safety incision, although there are limited studies assessing this risk. This simulation study on archival MRI films was performed to assess the risk for the popliteal neurovascular bundle and the peroneal nerve during passage of needles for inside\u2010out meniscus repair without a \u201csafety incision\u201d, thereby defining a \u201csafe zone\u201d of the menisci that can be safely repaired using this technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Archival MRI scans (<jats:italic>n<\/jats:italic>\u2009=\u200950) were retrieved and axial sections through the menisci were used for simulation. The needle passage was simulated for different points on the posterior horn and body of lateral and medial menisci at \u201chalf\u2010hour\u201d intervals using clock method (15\u00b0 intervals) with three different portals and two different needle cannulas, resulting in six different scenarios of needle passage for each point on the meniscus. The distance of the needle in each scenario was measured from popliteal vessels (<jats:italic>n<\/jats:italic>\u2009=\u200950) and peroneal nerve (<jats:italic>n<\/jats:italic>\u2009=\u200910). The value \u201cmean\u20103SD\u201d was calculated for positive means and \u201cMean\u2009+\u20093SD\u201d was calculated if the mean was negative. An additional 2\u00a0mm was defined as \u201csafe distance\u201d. Thus, simulation models in which the mean\u2009\u2212\u20093SD was less than 2\u00a0mm (or mean\u2009+\u20093SD was greater than \u2212\u20092\u00a0mm for negative means) were labelled as \u201cunsafe\u201d.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Needle passage through medial meniscus at and medial to 1 o\u2019clock position for a right knee (or 11 o\u2019clock position for a left knee) was safe, irrespective of the portal and needle type. For the lateral meniscus, only the equatorial region was found to be safe with this method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The popliteal neurovascular bundle is safe during the inside\u2010out medial meniscal repair without a safety incision. For the terminal\u2010most part of the posterior horn, the AM portal and the straight cannula should be avoided. However, this method without safety incision cannot be recommended for lateral meniscus because of the risk to the popliteal vessels and the peroneal nerve. Instead, the inside\u2010out method with a safety incision, or an all\u2010inside method should be used for lateral meniscus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-018-5060-x","type":"journal-article","created":{"date-parts":[[2018,7,17]],"date-time":"2018-07-17T02:28:57Z","timestamp":1531794537000},"page":"153-165","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Popliteal neurovascular bundle is safe during inside\u2010out repair of medial meniscus without a safety incision"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9788-5703","authenticated-orcid":false,"given":"Himanshu","family":"Gupta","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Sports Injury Centre VMMC and Safdarjung Hospital New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohini Gupta","family":"Ghasi","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Radiodiagnosis VMMC and Safdarjung Hospital New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Himanshu","family":"Kataria","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Sports Injury Centre VMMC and Safdarjung Hospital New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vineet","family":"Jain","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Sports Injury Centre VMMC and Safdarjung Hospital New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Shankar","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Sports Injury Centre VMMC and Safdarjung Hospital New Delhi India"},{"name":"<!--<label>3<\/label>--> Department of Orthopaedics All India Institute of Medical Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh Kumar","family":"Daripa","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Sports Injury Centre VMMC and Safdarjung Hospital New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish Datt","family":"Upadhyay","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Department of Biostatistics All India Institute of Medical Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,7,17]]},"reference":[{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010011\u20101489\u2010x"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2015.07.017"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s001670050215"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2010.09.010"},{"key":"e_1_2_9_6_2","unstructured":"BaenaAE.Arthroscopic inside\u2010out repair of the posterior horn of the medial meniscus. 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IEC\/SJH\/VMMC\/Project\/May-2016\/583).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Waiver for informed consent was obtained from the Institutional Ethics Committee as the study was performed on archival MRI data.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}