The Transseptal Arthroscopic Knee Portal Is in Close Proximity to the Popliteal Artery: A Cadaveric Study

Abstract

The purpose of this study was to use fluoroscopy to measure the distance between the transseptal portal and the popliteal artery under arthroscopic conditions with an intact posterior knee capsule, and to determine the difference between 90 degrees of knee flexion and full extension. The popliteal artery of eight fresh-frozen cadaveric knees was dissected and cannulated proximal to the knee joint. The posterolateral, posteromedial, and transseptal portals were then established at 90 degrees of flexion. A 4-mm switching stick was placed through the transseptal portal, and barium contrast was injected into the popliteal artery. A lateral fluoroscopic image was taken with the knee in 90 degrees of flexion and full extension, and the distance between the popliteal artery and the switching stick was measured and compared using a paired t-test. In knee flexion, the average distance between the transseptal portal and the anterior aspect of the popliteal artery for the eight cadaveric specimens was 12.0 mm ± 3.3 mm; in extension, this decreased to 9.0 mm ± 2.7 mm. The distance between the transseptal portal and popliteal artery was significantly higher at 90 degrees of knee flexion as compared with extension (p = 0.0005). The transseptal posterior knee arthroscopic portal must be carefully created due to the close proximity to the popliteal artery, and may be closer to the artery than previously reported in specimens with an intact posterior knee capsule. Creating the portal with the knee in flexion significantly displaces the popliteal artery away from the portal reducing the risk of arterial injury.

Keywords

transseptal portal - knee arthroscopy - popliteal artery - complications

Note

This investigation was performed at the University of Virginia Health System.

• References

• 1 Louisia S, Charrois O, Beaufils P. Posterior “back and forth” approach in arthroscopic surgery on the posterior knee compartments. Arthroscopy 2003; 19 (03) 321-325
• 2 Ahn JH, Ha CW. Posterior trans-septal portal for arthroscopic surgery of the knee joint. Arthroscopy 2000; 16 (07) 774-779
• 3 Kim S-J, Jung K-A, Kwun J-D, Kim J-M. Arthroscopic synovectomy of the knee joint in rheumatoid arthritis: surgical steps for complete synovectomy. Arthroscopy 2006; 22 (04) 461.e1-461.e4
• 4 Kim SJ, Shin SJ, Choi NH, Cho SK. Arthroscopically assisted treatment of avulsion fractures of the posterior cruciate ligament from the tibia. J Bone Joint Surg Am 2001; 83-A [phone]
• 5 Mariani PP. Arthroscopic release of the posterior compartments in the treatment of extension deficit of knee. Knee Surg Sports Traumatol Arthrosc 2010; 18 (06) 736-741
• 6 Ahn JH, Chung YS, Oh I. Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal. Arthroscopy 2003; 19 (01) 101-107
• 7 Complications of arthroscopy and arthroscopic surgery: results of a national surgery. Committee on Complications of Arthroscopy Association of North America. Arthroscopy 1985; 1 (04) 214-220
• 8 Small NC. Complications in arthroscopic surgery performed by experienced arthroscopists. Arthroscopy 1988; 4 (03) 215-221
• 9 Ritt MJ, Te Slaa RL, Koning J, Bruijn JD. Popliteal pseudoaneurysm after arthroscopic meniscectomy. A report of two cases. Clin Orthop Relat Res 1993; (295) 198-200
• 10 Makino A, Costa-Paz M, Aponte-Tinao L, Ayerza MA, Muscolo DL. Popliteal artery laceration during arthroscopic posterior cruciate ligament reconstruction. Arthroscopy 2005; 21 (11) 1396
• 11 Jimenez F, Utrilla A, Cuesta C. , et al. Popliteal artery and venous aneurysm as a complication of arthroscopic meniscectomy. J Trauma 1988; 28 (09) 1404-1405
• 12 Makridis KG, Wajsfisz A, Agrawal N, Basdekis G, Djian P. Neurovascular anatomic relationships to arthroscopic posterior and transseptal portals in different knee positions. Am J Sports Med 2013; 41 (07) 1559-1564
• 13 Matava MJ, Sethi NS, Totty WG. 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 2000; 16 (08) 796-804
• 14 Cosgarea AJ, Kramer DE, Bahk MS, Totty WG, Matava MJ. Proximity of the popliteal artery to the PCL during simulated knee arthroscopy: implications for establishing the posterior trans-septal portal. J Knee Surg 2006; 19 (03) 181-185
• 15 Kim S-J, Song H-T, Moon H-K, Chun Y-M, Chang W-H. The safe establishment of a transseptal portal in the posterior knee. Knee Surg Sports Traumatol Arthrosc 2011; 19 (08) 1320-1325
• 16 Pace JL, Wahl CJ. Arthroscopy of the posterior knee compartments: neurovascular anatomic relationships during arthroscopic transverse capsulotomy. Arthroscopy 2010; 26 (05) 637-642
• 17 Gillquist J, Hagberg G. A new modification of the technique of arthroscopy of the knee joint. Acta Chir Scand 1976; 142 (02) 123-130