In Israel, these are my disclosures and my partner's disclosures. Otoscopic meniscal repair is one of the most common orthopedic procedures. All inside suturing of the posterior horn of the lateral meniscus carries a risk for a rare, however, possibly devastating injury to the popliteal neurovascular bundle. Complications include massive bleeding, pseudoaneurysm, and fistula formation, and may consequently result in revision surgery and even amputation. The purpose of this study was to assess the risk of damage to the popliteal neurovascular bundle with all inside suture of the posterior horn of the lateral meniscus. We used axial cross-section magnetic resonance imaging of the MRI to simulate the trajectory of all inside suturing device when attempting to suture the lateral meniscus. We simulated all inside suturing of the posterior horn of the lateral meniscus using axial plane cross-section MRI. Lines were drawn from a conventional inframedial and infralateral portals near the patella tendon edge to the posterior horn of the lateral meniscus at increasing distance from the PCL at 0, 3, 6, 9, and 12 millimeters. Distance from each of these lines to the neurovascular bundle was measured. A similar analysis was performed for portals one centimeter medial and one centimeter lateral to the conventional portals. On the left, we see an axial MRI of a young female. On the right, of an older patient male. In red, we see the popliteal artery. In blue, the popliteal vein, yellow, the tibial nerve, and D, the distance between the posterior horn of the lateral meniscus and the neurovascular bundle. In order to do the simulation of the all inside suture device trajectory at different distance from the PCL, we drew lines from the anteromedial portal and lines from the anterolateral portal with the distance from the trajectory of the lines to the neurovascular bundle depicted in this D. These are simulations of these trajectory lines from one centimeter medial to the medial portal and one centimeter lateral to the lateral portal with the same depictions results. We have examined 60 MRI patients with the mean age of 44, range 18 to 79. There were 20 females and 40 males, same right and left knees. We examined the cross-sectional area of the MRIs which were about 11,000 millimeters square. The distance from the posterior horn lateral meniscus to the popliteal neurovascular bundle was mean of 7.8 millimeters with a range of 1.5 to 13 millimeters. If we look at distances from the PCL with a zero millimeter, then looking at the trajectory lines from the most lateral portal gained the more distance from the neurovascular bundle which was 2.7 millimeters. As we went towards the popliteus, we're moving away from the PCL. The most distant trajectory lines when trajectory lines were made from the medial portal one centimeter medial to the medial portal. These were significant. When we use a curved lines, then, can you move backwards? Can you move one backward please? Can you move forward please? If you use a curved device from the lateral portal, then if you aim it towards the PCL, you have the safest distance. In conclusion, young and female patients have shorter distance between the posterior-lateral meniscus and the neurovascular bundle. All-inside suturing of the posterior-lateral meniscus at zero millimeters from the PCL is safer using the more lateral portal. Beyond three millimeter from the PCL, a more medial portal is a safer option. Preoperative MRI assessment may assist in safer portal selection when planning repair of the posterior-lateral meniscus. Thank you.

popliteal neurovascular bundle

all inside suturing

Magnetic resonance imaging

posterior cruciate ligament

preoperative MRI assessment