An anatomical study of the meniscal roots of the knee: landmarks for its surgical reconstruction and implications for knee surgeons.

PURPOSE: The aim of this anatomical study was to describe the anatomy of the meniscal roots and their relationships with respect to the main adjacent structures in order to improve their surgical reconstruction. METHODS: Fourteen knees were included. The mean age of the donors was 92 years (range 89-96). We studied the general characteristics of the anterior and posterior roots of the medial meniscus and lateral meniscus by measuring their widths at their base and area. We investigated the relations between anterior and posterior roots of the medial and lateral menisci with respect to the anterior and posterior cruciate ligaments (ACL and PCL). RESULTS: The mean width of the anterior root of the lateral meniscus was 10.5 ± 1.4 mm. The mean width of the anterior root of the medial meniscus was 10 ± 1.5 mm. The mean width of the posterior root of lateral meniscus was 11.4 ± 1.4 mm. The mean width of the posterior root of medial meniscus was 10.5 ± 1.0 mm. The mean distance between the anterior cruciate ligament and the anterior root of lateral meniscus was 9.8 ± 2.9 mm, for the medial meniscus it was 15.9 ± 3.4 mm. The mean distance between the posterior cruciate ligament and the posterior root of the lateral meniscus was 11.5 ± 2.7 mm, for the medial meniscus, it was 11 ± 2.6 mm. CONCLUSION: The anterior and posterior meniscal roots have precise landmarks, and this article contributes to define the location of the meniscal roots with respect to their adjacent anatomical structures: ACL, PCL and intercondylar tubercle. Having precise measures of the distances between the meniscus roots and these structures allows knee surgeons to perform ACL reconstruction, meniscal root repair and meniscal allograft transplantation.

Relationships of the superficial fibular nerve and sural nerve with respect to the lateral malleolus: implications for ankle surgeons.

PURPOSE: Superficial fibular nerve (SFN) and sural nerve are at risk during osteosynthesis of the lateral malleolus. The aim of this anatomical study was to describe the relationships of the superficial fibular and sural nerves with respect to the lateral malleolus. METHODS: Nine corpses (18 ankles) were dissected, using a direct lateral approach. Measurements were recorded between the fibula and the nerves, and the pattern variations of the SFN were recorded for both right and left side to assess intra-individual variability. RESULTS: Distance between the tip of the lateral malleolus and the piercing of fascia cruris was 111 ± 26 mm for type 1 pattern, and range was 46-161 mm all types included. 78% (14 SFN) were type 1 pattern, 17% (3 SFN) were type 2 pattern, and 5% (1 SFN) were type 3 pattern. 44% (4 specimen) had a type 1 pattern SFN on one ankle and another pattern on the other ankle. The sural nerve was always observed just posterior to the lateral malleolus. CONCLUSION: This study demonstrated a great inter-individual variability especially for the SFN, but also an intra-individual variability with frequent different patterns between right and left leg. It is important to know the anatomical variations of the SFN and sural nerve to decrease the risk of intra operative nerve injury during direct lateral approach of lateral malleolus.