arthroscopy

Neurological complications

general
Incidence

·      complications uncommon

·      overall < 1%

·      neurological complications rare

·      incidence 0.1%

Aetiology

Direct injury

·      from incorrect placement of portals

·      risk reduced by

·      correct placement

·      use of blunt trocar

Compartment syndrome

·      from extravasation of fluid for distension of joint

·      risk reduced by

·      minimisation of pressure used

·      minimisation of duration of procedure

·      use of readily absorbed physiological solution

·      minimisation of number of capsular punctures

·      palpation of extremity at end of procedure

Neuropraxia

Tourniquet

·      risk reduced by

·      minimisation of duration (<90 min in upper limb and <120 min in lower limb)

·      minimisation of pressure (< 250 mm Hg in upper limb and <350 mm Hg in lower limb)

·      adequate cuff width

Positioning

·      direct pressure on nerve from inappropriate positioning

Reflex sympathetic dystrophy

·      uncommon

·      should be considered with

·      prolonged pain

·      vasomotor disturbance

·      delayed functional recovery

·      trophic changes

knee
Direct injury

Infrapatellar branch

·      may be injured by direct puncture for anteromedial portal

Saphenous nerve

·      may be injured by

·      direct puncture for posteromedial portal

·      passage of needles during arthroscopic meniscal repair

·      retraction during open meniscal repair

Common peroneal nerve

·      may be injured by

·      direct puncture for posterolateral portal

·      passage of needles for arthroscopic meniscal repair

·      entrapment by sutures of meniscal repair

Tibial nerve

·      may be injured by posterior penetration

Compartment syndrome

·      fluid may enter through rupture of synovial pouch

·      into knee through suprapatellar pouch

·      into calf through semimembranosus bursa

·      should check circumference of thigh and tension of tissue at end of procedure

Neuropraxia

·      usually from tourniquet

Nerves

Saphenous nerve

·      most commonly injured

·      usually from portal

·      sometimes from meniscal suture

·      can be avoided by

·      direct dissection and identification

·      use of retractor to deflect needles

Common peroneal nerve

·       next most common

·      usually from meniscal suture

·      can be avoided by

·      flexion of knee

·      direct dissection and identification

·      use of retractor to deflect needles