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Dzidzishvili L, Bi AS, Ostojic M, Chahla J. Combined lateral meniscus posterior root and meniscofemoral ligament injuries increase tibiofemoral forces and compromise rotational stability in ACL-deficient and reconstructed knees: A systematic review and meta-analysis of biomechanical studies. J Exp Orthop 2025; 12:e70227. [PMID: 40182611 PMCID: PMC11966645 DOI: 10.1002/jeo2.70227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Revised: 02/18/2025] [Accepted: 02/24/2025] [Indexed: 04/05/2025] Open
Abstract
Purpose To compare biomechanical evidence on joint compression forces and rotational stability between isolated lateral meniscus posterior root (LMPR) tears and those with concurrent meniscofemoral ligament (MFL) injuries, with a secondary focus on assessing rotational stability in ACL-deficient and ACL-reconstructed knees. Methods A comprehensive literature review was conducted following the 2020 PRISMA guidelines, using the Scopus, PubMed, and Embase databases from their inception through 7 October 2024. This review included biomechanical studies on healthy animal or human cadaveric knees that assessed lateral compartment contact area and peak pressure following isolated LMPR and MFL injuries, as well as kinematic outcomes in anterior cruciate ligament (ACL) deficient knees. The methodological quality of the studies was assessed using the Quality Appraisal for Cadaveric Studies (QUACS) scale. Results Twelve studies involving 116 knees-86 human cadaveric and 30 porcine models-assessed tibiofemoral contact mechanics (contact area and pressure) and kinematic data. Both isolated LMPR tear and the combination of LMPR and MFL injuries significantly increased mean contact pressure in the lateral compartment compared to the intact state (p = 0.004 and <0.001, respectively). However, isolated LMPR tear did not significantly increase peak pressure in the lateral compartment (p = 0.55), whereas the combination with MFL injury caused a substantial rise (<0.001). LMPR repair restored both contact and peak pressures to levels that were not significantly different from those observed in the intact state (p = 0.86 and <0.28, respectively). Additionally, the combination of LMPR tear, MFL injury and ACL sectioning further increased anterior tibial translation (ATT) and internal tibial rotation (IR) during a simulated pivot shift test compared to isolated LMPR tear (<0.001). Although LMPR repair reduced rotational instability, it did not significantly restore ATT (p = 0.63) and IR (p = 0.923) during simulated pivot shifts in ACL-reconstructed knees. Conclusions A combined injury to the LMPR and MFL significantly increases mean and peak contact pressures in the lateral compartment compared to isolated LMPR tear and intact states, with LMPR repair restoring contact pressure to near-normal levels. However, in knees with ACL deficiency or reconstruction, LMPR tear with MFL injury significantly increases IR during pivot shift testing, with LMPR repair unable to restore rotational stability to intact-state levels. Level of Evidence Level IV, systematic review of biomechanical studies.
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Affiliation(s)
- Lika Dzidzishvili
- European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA), Basic Science CommitteeLuxembourgLuxembourg
- Department of Orthopaedic Surgery and Traumatology, Knee Surgery and Arthroscopy Unit, Hospital Universitari Germans Trias i PujolUniversidad Autónoma de BarcelonaBarcelonaSpain
| | - Andrew S. Bi
- Department of Orthopaedic SurgeryRush University Medical Center, Midwest Orthopedics at RushChicagoIllinoisUSA
| | - Marko Ostojic
- European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA), Basic Science CommitteeLuxembourgLuxembourg
- Department of Sports Medicine and Knee, Orthopaedics and Traumatology ClinicUniversity Hospital “Sisters of Mercy”ZagrebCroatia
| | - Jorge Chahla
- Department of Orthopaedic SurgeryRush University Medical Center, Midwest Orthopedics at RushChicagoIllinoisUSA
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Yeo IS, Hong JE, Yang HM. Histomorphometric analysis of anterior cruciate ligament bundles and anatomical insights into injury mechanisms. Sci Rep 2025; 15:6762. [PMID: 40000733 PMCID: PMC11861305 DOI: 10.1038/s41598-025-88037-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 01/23/2025] [Indexed: 02/27/2025] Open
Abstract
The anterior cruciate ligament consists of two bundles, the anteromedial and posterolateral bundles, which are frequently associated with meniscal dysfunction. Despite previous studies investigating the relationship between biomechanical instability and injury, a comprehensive histological analysis of the anatomical aspects contributing to injury and degenerative changes and the structural connectivity between the anterior cruciate ligament and the meniscus is lacking. Masson's trichrome, pentachrome, Safranin-O, and modified Verhoeff-Van Gieson histological stains and microcomputed tomography were used in this analysis. The anteromedial bundle of the anterior cruciate ligament is tightly connected to the medial meniscus via articular cartilage, whereas the posterolateral bundle is loosely connected to the transition zone of the lateral meniscus via connective tissue. Due to the differences in the structural connectivity between the meniscus and each anterior cruciate ligament bundle, the degree of deformation of the space between the two bundles varies significantly with knee flexion angle. Furthermore, the two bundles exhibit histological differences in the ratio of elastic fibers to collagen at regions. Specifically, the ratios of the upper and lower parts were 11.36 ± 0.90% and 4.87 ± 0.34%, respectively, for the anteromedial bundle, and 10.33 ± 0.37% and 5.32 ± 0.78%, respectively, for the posterolateral bundle.
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Affiliation(s)
- In-Seung Yeo
- Department of Anatomy, College of Medicine, The Soonchunhyang University of Korea, Dongnam-Gu, Cheonan-si, 31151, Chungcheongnam-do, Republic of Korea
- Translational Research Unit for Anatomy and Analgesia, Seoul, Republic of Korea
| | - Ju-Eun Hong
- Department of Biomedical Laboratory Science, College of Software and Digital Healthcare convergence, Yonsei University MIRAE Campus, Wonju, Republic of Korea
| | - Hun-Mu Yang
- Translational Research Unit for Anatomy and Analgesia, Seoul, Republic of Korea.
- Department of Anatomy, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Yoshihara A, Mouton C, Siboni R, Nakamura T, Sekiya I, Koga H, Seil R, Nakagawa Y. Combined use of cleft and truncated triangle signs helps improve the preoperative MRI diagnosis of lateral meniscus posterior root tears in patients with ACL injuries. Knee Surg Sports Traumatol Arthrosc 2025. [PMID: 39865480 DOI: 10.1002/ksa.12597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Revised: 01/06/2025] [Accepted: 01/07/2025] [Indexed: 01/28/2025]
Abstract
PURPOSE This study aimed to investigate whether combining the analysis of different magnetic resonance imaging (MRI) signs enhances the diagnostic accuracy of lateral meniscus posterior root tears (LMPRTs) in patients with anterior cruciate ligament (ACL) injuries. We hypothesised that analysing the cleft, ghost and truncated triangle signs and lateral meniscus extrusion (LME) measurement together would improve the preoperative MRI-based diagnosis of LMPRTs. METHODS This retrospective study used prospectively collected registry data from two academic centres, including patients undergoing primary or revision ACL reconstruction (ACLR) and LMPRT repair. The control group included age- and sex-matched (1:1) patients undergoing ACLR without any lateral meniscus tears. LME (mm) and the presence of cleft, ghost and/or truncated triangle signs were evaluated using preoperative MRI. RESULTS In total, 252 patients (126 per group) were included. Individually, the cleft and truncated triangle signs achieved the highest sensitivity (60% and 62%, respectively) and accuracy (>89%). The presence of either sign increased sensitivity to 79% and enabled the correct classification of 93% of ACL injuries as having or not having an LMPRT, with high specificity (95%) and good positive predictive value (74%). This combination was considered the most efficient in reducing false positives and false negatives. The LME (cutoff value: 2.2 mm) and ghost sign had lower sensitivities (50% and 14%, respectively) and accuracies (83% and 87%) and were not part of the optimal combination. CONCLUSION The cleft and/or truncated triangle signs on preoperative MRI reliably detected 79% of LMPRTs in this cohort, with high specificity (95%) and good positive predictive value (74%). This combination provides an effective method for achieving reasonable sensitivity while minimising false positives, aiding surgeons in preoperative diagnosis and planning for LMPRT repair. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Aritoshi Yoshihara
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Renaud Siboni
- Department of Orthopaedic Surgery, Reims University Hospital, Reims, France
- Biomaterial and Inflammation in Bone Site Laboratory (EA 4691 Bios), University of Reims Champagne Ardenne, Reims, France
| | - Tomomasa Nakamura
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Institute of Science Tokyo, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan
- Department of Cartilage Regeneration, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan
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Perelli S, Conte P, Pizza N, Morales‐Avalos R, Kon E, Grassi A, Zaffagnini S, Monllau JC. Meniscal extrusion: Proposal for a novel qualitative classification. J Exp Orthop 2025; 12:e70126. [PMID: 39741910 PMCID: PMC11685843 DOI: 10.1002/jeo2.70126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 10/30/2024] [Accepted: 11/05/2024] [Indexed: 01/03/2025] Open
Abstract
Meniscal extrusion (ME), defined as the radial displacement of the meniscal body outside the margins of the tibial plateau, has been seen as an independent and relevant predictor of intra-articular knee degeneration. Nonetheless, available classifications for ME are exclusively quantitative assessments not considering the context in which extrusion is identified. Indeed, ME can be the result of several different conditions spanning from acute tears to chronic degeneration and its definition cannot be only dependent on the numeric calculation of the radial displacement of the meniscal body. Furthermore, growing evidence supports the existence of a paraphysiological ME resulting from joint loading, limb malalignment, anatomical abnormalities of the meniscal attachments to the femur and tibia or a nonpathological finding after meniscal allograft transplantation. It is therefore clear that an exclusively quantitative assessment of ME cannot be sufficient since this condition can develop in such different clinical scenarios. For this reason, a novel qualitative classification for ME is proposed, differentiating between three distinct conditions: a paraphysiological ME, a pathological ME and ME related to degenerative conditions. Furthermore, a comprehensive review of the present literature has been conducted to report the most relevant and updated evidence on the topic highlighting the difference in the clinical management of each different category. Level of Evidence Not applicable.
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Affiliation(s)
- Simone Perelli
- ICATKnee, Institut Català de Traumatologia i Medicina de l'Esport (ICATME)‐Hospital Universitari DexeusUniversitat Autònoma de BarcelonaBarcelonaSpain
- Department of Surgery and Morphologic Science, Orthopaedic Surgery ServiceUniversitat Pompeu Fabra, Hospital del MarBarcelonaSpain
| | - Pietro Conte
- ICATKnee, Institut Català de Traumatologia i Medicina de l'Esport (ICATME)‐Hospital Universitari DexeusUniversitat Autònoma de BarcelonaBarcelonaSpain
- IRCCS Humanitas Research HospitalRozzanoMilanoItaly
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMilanoItaly
| | - Nicola Pizza
- ICATKnee, Institut Català de Traumatologia i Medicina de l'Esport (ICATME)‐Hospital Universitari DexeusUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Rodolfo Morales‐Avalos
- Department of Physiology, Laboratory of Biomechanics, School of MedicineUniversidad Autónoma de Nuevo LeónMonterreyMexico
| | - Elizaveta Kon
- IRCCS Humanitas Research HospitalRozzanoMilanoItaly
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMilanoItaly
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica IIIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica IIIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Joan Carles Monllau
- ICATKnee, Institut Català de Traumatologia i Medicina de l'Esport (ICATME)‐Hospital Universitari DexeusUniversitat Autònoma de BarcelonaBarcelonaSpain
- Department of Surgery and Morphologic Science, Orthopaedic Surgery ServiceUniversitat Pompeu Fabra, Hospital del MarBarcelonaSpain
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Petersen W, Mustafa HA, Fricke LV, Braun K, Häner M. [Refixation of a posterior medial root lesion in combination with centralization by a meniscotibial suture]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2024:10.1007/s00064-024-00858-6. [PMID: 39172276 DOI: 10.1007/s00064-024-00858-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE Refixation of a posterior root lesion of the medial meniscus via a tibial drill tunnel and prevention of extrusion using a meniscotibial suture (centralization). INDICATIONS Posterior root lesion of the medial meniscus. CONTRAINDICATIONS Grade 4 cartilage damage in the corresponding compartment, uncorrected varus or valgus deformities, symptomatic instabilities, extensive degenerative tears apart from the root region. SURGICAL TECHNIQUE Knee arthroscopy via the high anterolateral standard portal. Diagnostic arthroscopy to check indication. Locate the insertion zone on the tibial plateau and local debridement until the bone of the tibial plateau is visible. Insertion of a targeting device and drilling of a targeting wire into the center of the insertion zone in the area of the intercondylar eminence. Overdrill the target wire with a 4.5 mm drill. Reinforcement of the medial meniscus posterior horn with braided suture material. The reinforcing thread is inserted into the bone tunnel via an eyelet wire with a thread loop. Optional additional centralization with incision in the middle part of the meniscus. Reinforcement of the meniscus base with braided suture material using the "outside in" technique and fixation of the inner meniscus base at the edge of the tibial plateau using a transosseous extraction suture or a suture anchor. POSTOPERATIVE MANAGEMENT Six weeks nonweight-bearing (0 kg), then gradually increased load. Range of motion: 4 weeks E/F 0-0-60°, 2 weeks 0-0-90°, optionally use of a valgus brace (varus of < 5°). RESULTS In root lesions of the medial meniscus, transosseous refixation significantly improves knee function (Lysholm, Hospital for Special Surgery, International Knee Documentation Committee, visual analog scale for pain, Tegner, and Knee Injury and Osteoarthritis Outcome scores) and reduces osteoarthritis progression. However, a transosseous suture alone could not significantly reduce postoperative extrusion. However, previous studies have shown that additional centralization can significantly reduce extrusion.
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Affiliation(s)
- Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyß-Str. 27-31, 14193, Berlin, Deutschland.
| | - Hassan Al Mustafa
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyß-Str. 27-31, 14193, Berlin, Deutschland
| | - Leo Vincent Fricke
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyß-Str. 27-31, 14193, Berlin, Deutschland
| | - Karl Braun
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyß-Str. 27-31, 14193, Berlin, Deutschland
| | - Martin Häner
- Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar Theyß-Str. 27-31, 14193, Berlin, Deutschland
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Feroe AG, Clark SC, Hevesi M, Okoroha KR, Saris DBF, Krych AJ, Tagliero AJ. Management of Meniscus Pathology with Concomitant Anterior Cruciate Ligament Injury. Curr Rev Musculoskelet Med 2024; 17:321-334. [PMID: 38822979 PMCID: PMC11219633 DOI: 10.1007/s12178-024-09906-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize current clinical knowledge on the prevalence and types of meniscus pathology seen with concomitant anterior cruciate ligament (ACL) injury, as well as surgical techniques, clinical outcomes, and rehabilitation following operative management of these pathologies. RECENT FINDINGS Meniscus pathology with concomitant ACL injury is relatively common, with reports of meniscus pathology identified in 21-64% of operative ACL injuries. These concomitant injuries have been associated with increased age and body mass index. Lateral meniscus pathology is more common in acute ACL injury, while medial meniscus pathology is more typical in chronic ACL deficiency. Meniscus tear patterns associated with concomitant ACL injury include meniscus root tears, lateral meniscus oblique radial tears of the posterior horn (14%), and ramp lesions of the medial meniscus (8-24%). These meniscal pathologies with concomitant ACL injury are associated with increased rotational laxity and meniscal extrusion. There is a paucity of comparative studies to determine the optimal meniscus repair technique, as well as rehabilitation protocol, depending on specific tear pattern, location, and ACL reconstruction technique. There has been a substantial increase in recent publications demonstrating the importance of meniscus repair at the time of ACL repair or reconstruction to restore knee biomechanics and reduce the risk of progressive osteoarthritic degeneration. Through these studies, there has been a growing understanding of the meniscus tear patterns commonly identified or nearly missed during ACL reconstruction. Surgical management of meniscal pathology with concomitant ACL injury implements the same principles as utilized in the setting of isolated meniscus repair alone: anatomic reduction, biologic preparation and augmentation, and circumferential compression. Advances in repair techniques have demonstrated promising clinical outcomes, and the ability to restore and preserve the meniscus in pathologies previously deemed irreparable. Further research to determine the optimal surgical technique for specific tear patterns, as well as rehabilitation protocols for meniscus pathology with concomitant ACL injury, is warranted.
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Affiliation(s)
- Aliya G Feroe
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Sean C Clark
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Adam J Tagliero
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Zhang ZZ, Zhang HZ, Jiang C, Yang R, Chen Z, Song B, Li WP. Steep Posterior Tibial Slope and Excessive Anterior Tibial Translation Are Associated With Increased Sagittal Meniscal Extrusion After Posterior Lateral Meniscus Root Repair Combined With Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2024; 6:100881. [PMID: 38328534 PMCID: PMC10847029 DOI: 10.1016/j.asmr.2023.100881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/26/2023] [Indexed: 02/09/2024] Open
Abstract
Purpose To (1) evaluate the clinical and radiographic outcomes of patients with primary anterior cruciate ligament reconstruction (ACLR) with type II posterior lateral meniscus root tear (PLMRT) repair and (2) identify whether increased anterior tibial subluxation of the lateral compartment (ATSLC) and steeper posterior tibial slope (PTS) are associated with sagittal lateral meniscal extrusion (LME). Methods Patients who underwent primary anatomic ACLR with concomitant type II PLMRTs using the all-inside side-to-side repair technique between November 2014 and September 2020 were identified. To be included, patients must have had a minimum of 2 years follow-up. All patients, including those with ATSLC and PTS and sagittal and coronal LME, were retrospectively reviewed clinically and radiologically. The patients were divided into 2 subgroups according to the occurrence of sagittal LME. Results Forty patients were included in this study with a mean follow-up of 44 months (range, 24-94 months). In general, the postoperative parameters, including grade of pivot shift, side-to-side difference, ATSLC, Lysholm score, and International Knee Documentation Committee (IKDC) score, were significantly improved compared with the preoperative ones. However, postoperative sagittal LME was detected to be significantly larger than the preoperative one. Minimal clinically important difference (MCID) analysis for postoperative outcomes showed that the rate of patients who achieved MCID thresholds was 100% for Lysholm, 95% for IKDC, 42.50% for coronal LME, 62.50% for sagittal LME, 40% for ATSLC, and 100% for side-to-side difference. Further comparisons, where patients were divided into 2 subgroups according to the occurrence of sagittal LME, showed significant differences in PTS, ATSLC, and coronal LME. Conclusions Clinical outcomes after type II PLMRT repair with primary ACLR were significantly improved, except for LME, at the 2-year postoperative follow-up. After repair of type II PLMRT injuries, the presence of sagittal LME was associated with increased PTS and ATSLC. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Zheng-Zheng Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Hao-Zhi Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Chuan Jiang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Rui Yang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Zhong Chen
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Bin Song
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
| | - Wei-Ping Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P. R. China
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Meng C, Ren Y, Kong L, Guo J, Zhao Y, Han C. Arthroscopic Lateral Meniscus Root Repair With Reverse Suture Anchor Technique. Arthrosc Tech 2024; 13:102857. [PMID: 38435270 PMCID: PMC10907916 DOI: 10.1016/j.eats.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/30/2023] [Indexed: 03/05/2024] Open
Abstract
The stability of the knee joint is crucially dependent on the integrity of the lateral meniscus posterior root, which is often accompanied by anterior cruciate ligament injury. Anchor suture repair for lateral meniscus posterior root injury not only achieves better biomechanical effects but also ensures favorable prognosis. However, the placement of anchors often requires the establishment of a posterior approach, and the insertion of an anchor is a technical challenge. In light of this, we have applied the technique of reverse anchor fixation for repairing the lateral meniscus posterior root, which not only simplifies the procedure but also effectively reduces the "bungee effect."
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Affiliation(s)
- Chenyang Meng
- Department of Sport Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yizhong Ren
- Department of Sport Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Lingyue Kong
- Department of Sport Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Jiantao Guo
- Department of Surgical, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yunan Zhao
- Department of Sport Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Changxu Han
- Department of Sport Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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Häner M, Petersen W. [Treatment of acute injury of the anterior cruciate ligament : Always only reconstruction?]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:8-17. [PMID: 37597054 DOI: 10.1007/s00113-023-01357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/21/2023]
Abstract
The aim of treatment of a ruptured anterior cruciate ligament (ACL) is the return of the patient to an acceptable level of activity without giving way phenomena as well as adequate treatment of prognostically relevant concomitant lesions. The treatment of acute ACL ruptures can be either early reconstruction or a primary physiotherapy with optional later reconstruction. Which path is taken depends on possible concomitant injuries that require early surgical intervention (e.g., repairable meniscal injury or distal rupture of the medial collateral ligament) and on patient-specific factors (age, level of activity). Isolated ruptures of the ACL can also be primarily treated without surgery. Then the injured knee joint should first be so far conditioned by rehabilitative measures that pain, swelling and posttraumatic restriction of movement are improved and neuromuscular training can be started. A screening test consisting of jumping tests, patient-reported outcome measures and the testing for giving way phenomena can be suitable to differentiate compensators (copers) from noncompensators (non-copers). Surgical reconstruction of the ACL should be recommended to non-compensators in the sense of participatory decision-making. Activity modification (adapter) can also be considered as a treatment strategy. If instability events (giving way) or secondary meniscal lesions occur during nonsurgical therapy, cruciate ligament reconstruction should be considered.
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Affiliation(s)
- Martin Häner
- Sportklinik Berlin und Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar-Theyß-Str. 27-31, 14193, Berlin, Deutschland
| | - Wolf Petersen
- Sportklinik Berlin und Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar-Theyß-Str. 27-31, 14193, Berlin, Deutschland.
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Yoshihara A, Siboni R, Nakagawa Y, Mouton C, Jacquet C, Nakamura T, Sekiya I, Seil R, Koga H. Lateral-medial asymmetry of posterior tibial slope and small lateral tibial plateau articular surface depth are morphological factors of lateral meniscus posterior root tears in ACL-injured patients. Knee Surg Sports Traumatol Arthrosc 2023; 31:3594-3603. [PMID: 36656347 DOI: 10.1007/s00167-023-07317-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE To investigate whether knee morphological features, patient characteristics, and intraoperative findings are associated with a lateral meniscus (LM) posterior root tear (LMPRT) in anterior cruciate ligament (ACL) injuries with the integrated data from two academic centres. METHODS This retrospective study used registry data acquired prospectively at two academic centres. Patients with ACL reconstruction (ACLR) with LMPRT and no other LM injury were selected (LMPRT group) from each database. The control group included patients who underwent ACLR without LM tears. Patients were matched to the LMPRT group according to age and gender (1:1). Morphological factors evaluated on preoperative magnetic resonance image scans included lateral femoral condyle (LFC) anterior-posterior diameter, height, and depth; lateral tibial plateau (LTP) articular surface (AS) depth and sagittal plane depth; and lateral and medial posterior tibial slopes (PTSs). LFC height and depth ratios, LTP AS depth and sagittal plane depth ratios, and lateral-to-medial slope asymmetry were computed from previous measurements. Patient characteristics and intraoperative findings were extracted and compared between both groups. RESULTS The study included 252 patients (126 in each group). The lateral-medial asymmetry of PTS was greater in the LMPRT group (1.2° vs 0.3°, p < 0.05), and the LTP AS depth was smaller in the LMPRT group (31.4 mm vs 33.2 mm, p < 0.01). There were no differences in LFC morphology between the control and LMPRT groups. Pivot shift grade (p < 0.05), percentage of complete ACL tears (p < 0.05), and medial meniscus ramp lesions (p < 0.05) were significantly higher in the LMPRT group. CONCLUSION LMPRT was associated with significantly increased lateral-medial asymmetry of PTS and significantly smaller LTP AS depth. LMPRT was also associated with an increase in the preoperative pivot shift grade and the presence of a medial meniscus ramp lesion. These morphological characteristics are rather simple to measure and would serve as helpful indicators to preoperatively detect LMPRT, which is frequently challenging to diagnose preoperatively. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Aritoshi Yoshihara
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Renaud Siboni
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg
- Department of Orthopedics Surgery, Reims Teaching Hospital, Reims, France
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg
- Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, Luxembourg, Luxembourg
| | - Christophe Jacquet
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg
- Department of Orthopaedic Surgery and Traumatology, Institute for Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Tomomasa Nakamura
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg
- Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, Luxembourg, Luxembourg
- Orthopaedics, Sports Medicine and Digital Methods, Human Motion, Luxembourg, Luxembourg
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan.
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Petersen W. Editorial Commentary: Traumatic and Atraumatic Meniscal Root Injuries Can Occur Both Medially and Laterally: No Rule Without Exceptions! Arthroscopy 2023; 39:1838-1840. [PMID: 37400168 DOI: 10.1016/j.arthro.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 07/05/2023]
Abstract
It took a long time for meniscal root injuries to slowly gain scientific and clinical attention some 40 years after the first arthroscopic meniscal resection. Medial root injuries are mostly degenerative in nature and often are associated with obesity and varus deformity. However, lateral root injuries are more commonly traumatic in origin and are associated with anterior cruciate ligament injuries. But, there is no rule without an exception. Laterally, there are isolated root injuries without anterior cruciate ligament involvement and also nontraumatic root injuries that can be associated with a valgus leg axis. Traumatic medial root injuries, on the other hand, occur in the context of knee dislocations. Therefore, the therapeutic concepts should not be based strictly on the localization medial or lateral but on the etiology, traumatic and not traumatic. Even though it has been shown that many patients benefit from refixation of the meniscus root, it seems sensible to search for the etiology of nontraumatic root injuries and to integrate this into the therapeutic concept (e.g., additional osteotomy to correct the varus or valgus deformity). However, the degenerative changes in the relevant compartment must also be taken into account. Recent biomechanical results on the influence of the meniscotibial (medial) or meniscofemoral (lateral) ligaments on extrusion are also relevant with regard to the success of root refixation. These results can provide the rationale for carrying out additional centralization.
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Tomsan H, Gorbachova T, Fritz RC, Abrams GD, Sherman SL, Shea KG, Boutin RD. Knee MRI: Meniscus Roots, Ramps, Repairs, and Repercussions. Radiographics 2023; 43:e220208. [PMID: 37384542 DOI: 10.1148/rg.220208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Menisci play an essential role in maintaining normal pain-free function of the knee. While there are decades of MRI literature on the tears involving the meniscus body and horns, there is now a surge in knowledge regarding injuries at the meniscus roots and periphery. The authors briefly highlight new insights into meniscus anatomy and then summarize recent developments in the understanding of meniscus injuries that matter, emphasizing meniscus injuries at the root and peripheral (eg, ramp) regions that may be missed easily at MRI and arthroscopy. Root and ramp tears are important to diagnose because they may be amenable to repair. However, if these tears are left untreated, ongoing pain and accelerated cartilage degeneration may ensue. The posterior roots of the medial and lateral menisci are most commonly affected by injury, and each of these injuries is associated with distinctive clinical profiles, MRI findings, and tear patterns. Specific diagnostic pitfalls can make the roots challenging to evaluate, including MRI artifacts and anatomic variations. As with root tears, MRI interpretation and orthopedic treatment have important differences for injuries at the medial versus lateral meniscus (LM) periphery (located at or near the meniscocapsular junction). Medially, ramp lesions typically occur in the setting of an anterior cruciate ligament rupture and are generally classified into five patterns. Laterally, the meniscocapsular junction may be injured in association with tibial plateau fractures, but disruption of the popliteomeniscal fascicles may also result in a hypermobile LM. Updated knowledge of the meniscus root and ramp tears is crucial in optimizing diagnostic imaging before repair and understanding the clinical repercussions. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available in the Online Learning Center.
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Affiliation(s)
- Hanna Tomsan
- From the Departments of Radiology (H.T., R.D.B.) and Orthopaedic Surgery (G.D.A., S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5119; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, Calif (R.C.F.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, Calif (K.G.S.)
| | - Tetyana Gorbachova
- From the Departments of Radiology (H.T., R.D.B.) and Orthopaedic Surgery (G.D.A., S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5119; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, Calif (R.C.F.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, Calif (K.G.S.)
| | - Russell C Fritz
- From the Departments of Radiology (H.T., R.D.B.) and Orthopaedic Surgery (G.D.A., S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5119; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, Calif (R.C.F.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, Calif (K.G.S.)
| | - Geoffrey D Abrams
- From the Departments of Radiology (H.T., R.D.B.) and Orthopaedic Surgery (G.D.A., S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5119; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, Calif (R.C.F.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, Calif (K.G.S.)
| | - Seth L Sherman
- From the Departments of Radiology (H.T., R.D.B.) and Orthopaedic Surgery (G.D.A., S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5119; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, Calif (R.C.F.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, Calif (K.G.S.)
| | - Kevin G Shea
- From the Departments of Radiology (H.T., R.D.B.) and Orthopaedic Surgery (G.D.A., S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5119; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, Calif (R.C.F.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, Calif (K.G.S.)
| | - Robert D Boutin
- From the Departments of Radiology (H.T., R.D.B.) and Orthopaedic Surgery (G.D.A., S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5119; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, Calif (R.C.F.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, Calif (K.G.S.)
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Baker HP, Bowen E, Sheean A, Bedi A. New Considerations in ACL Surgery: When Is Anatomic Reconstruction Not Enough? J Bone Joint Surg Am 2023; Publish Ahead of Print:00004623-990000000-00808. [PMID: 37205735 DOI: 10.2106/jbjs.22.01079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
➤ Clinicians should be careful to assess for associated injuries including anterolateral complex and medial meniscal ramp lesions or lateral meniscal posterior root tears.➤ Consideration of lateral extra-articular augmentation should be given for patients with >12° of posterior tibial slope.➤ Patients with preoperative knee hyperextension (>5°) or other nonmodifiable risk factors, including high-risk osseous geometry, may benefit from a concomitant anterolateral augmentation procedure to improve rotational stability.➤ Meniscal lesions should be addressed at the time of anterior cruciate ligament reconstruction with meniscal root or ramp repair.
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Affiliation(s)
- Hayden P Baker
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
| | | | - Andrew Sheean
- San Antonio Military Medical Center, San Antonio, Texas
| | - Asheesh Bedi
- Northshore University Health System, Skokie, Illinois
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Papalia GF, Za P, Saccone L, Franceschetti E, Zampogna B, Vasta S, Papalia R. Meniscal extrusion: risk factors and diagnostic tools to predict early osteoarthritis. Orthop Rev (Pavia) 2023; 15:74881. [PMID: 37197670 PMCID: PMC10184885 DOI: 10.52965/001c.74881] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Meniscal extrusion (ME) is strongly correlated with cartilage wear and osteoarthritis (OA), be-cause of the altered kinematic and the decreased contact area between the tibia and femur. The aim of this narrative review is to analyze the process of ME, focusing on the possible causes, and to evaluate the correlation between ME and knee OA, in order to provide early diagnosis and treatments. Studies written in English that analyzed the causes of ME, provided indications re-garding diagnosis and treatment, and evaluated the relation between ME and early OA were in-cluded. Injuries, degeneration of the meniscal substance and meniscus root tears are associated with significantly increased ME. An extruded meniscus could be a manifestation of other pa-thologies such as disruption of coronary ligaments, cartilage loss, knee malalignment, ligament injuries, or OA. ME is strongly associated with osteoarthritis features, particularly with bone marrow lesion and cartilage damage. Magnetic resonance imaging represents the gold standard for the detection of ME. The severity of the medial meniscus extrusion may also affect healing af-ter repair, and meniscus extrusion is not completely reduced by meniscus posterior root tear re-pair. In this study, we proved that ME represents an important risk factor for early knee OA. We provided alternative theories of ME, such as meniscal fibers injury first and "dynamic extrusion of the menisci". The phenomenon of aging has been described as a new concept in the etiology of ME. Finally, we stated all the main techniques and characteristics of the diagnostic process, as well as the current knowledge in the therapeutic field.
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Affiliation(s)
- Giuseppe Francesco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Pierangelo Za
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Luca Saccone
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Sebastiano Vasta
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Thomas B, de Villeneuve Florent B, Alexandre F, Martine P, Akash S, Corentin P, Matthieu O, Christophe J. Patients with meniscus posterolateral root tears repair during ACL reconstruction achieve comparable post-operative outcome than patients with isolated ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07415-x. [PMID: 37079048 DOI: 10.1007/s00167-023-07415-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/05/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Lateral posterior meniscal root tear (LPMRT) repair, at the time of anterior cruciate ligament (ACL) reconstruction are increasingly being performed. The aim of this study was to compare the clinical and functional outcomes, as well as the complication rates at a minimum of 2 years follow-up, between an isolated ACL reconstruction group with intact menisci and a combined ACL reconstruction and LPMRT repair group. METHODS All patients who underwent combined ACL reconstruction and LPMRT repair between 2016 and 2020 were included in the study. They were matched with an isolated ACL reconstruction group with intact menisci based on age, gender and the pre-injury IKDC score. The KOOS, ACLRSI Tegner-Lysholm score and the TELOS-test were collected pre- and postoperatively; complications (re-rupture, recurrence or persistence of a high grade pivot shift, new meniscal injury) were recorded. All LPMRTs were repaired using transtibial pull-out technique. RESULTS After matching, 100 patients were included in this study (mean age 29.6 ± 1.0 years and mean follow-up 42.9 ± 7.3 months): 50 patients in the isolated ACL reconstruction group with intact menisci (group A) and 50 in the combined ACL reconstruction and LPMRT repair group (group B). Preoperatively, patients in group B had significant lower KOOS scores (Global 55.9 ± 2.9 vs. 64.6 ± 2.3, p = 0.02), but similar ACLRSI, TEGNER and TELOS scores. At the last follow-up, all functional scores had improved, and no significant difference between the two groups on any score was observed. There was also no difference in terms of complications rates. CONCLUSION At a minimum of 2 years follow-up (mean follow-up 42.9 months), LPMRT repair during ACL reconstruction has no significant difference in terms of post-operative functional outcomes compared to the isolated ACL reconstruction group. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Bard Thomas
- CNRS, ISM UMR 7287, Aix-Marseille University, 13288, Marseille Cedex 09, France
- Department of Orthopedic Surgery and Traumatology, Institute of Movement and Locomotion, University Institute of Movement and Locomotion, St. Marguerite Hospital 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Bernard de Villeneuve Florent
- CNRS, ISM UMR 7287, Aix-Marseille University, 13288, Marseille Cedex 09, France
- Department of Orthopedic Surgery and Traumatology, Institute of Movement and Locomotion, University Institute of Movement and Locomotion, St. Marguerite Hospital 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Ferreira Alexandre
- CNRS, ISM UMR 7287, Aix-Marseille University, 13288, Marseille Cedex 09, France
- Department of Orthopedic Surgery and Traumatology, Institute of Movement and Locomotion, University Institute of Movement and Locomotion, St. Marguerite Hospital 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Pithioux Martine
- CNRS, ISM UMR 7287, Aix-Marseille University, 13288, Marseille Cedex 09, France
- Department of Orthopedic Surgery and Traumatology, Institute of Movement and Locomotion, University Institute of Movement and Locomotion, St. Marguerite Hospital 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Sharma Akash
- CNRS, ISM UMR 7287, Aix-Marseille University, 13288, Marseille Cedex 09, France
- Department of Orthopedic Surgery and Traumatology, Institute of Movement and Locomotion, University Institute of Movement and Locomotion, St. Marguerite Hospital 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Pangaud Corentin
- CNRS, ISM UMR 7287, Aix-Marseille University, 13288, Marseille Cedex 09, France
- Department of Orthopedic Surgery and Traumatology, Institute of Movement and Locomotion, University Institute of Movement and Locomotion, St. Marguerite Hospital 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Ollivier Matthieu
- CNRS, ISM UMR 7287, Aix-Marseille University, 13288, Marseille Cedex 09, France.
- Department of Orthopedic Surgery and Traumatology, Institute of Movement and Locomotion, University Institute of Movement and Locomotion, St. Marguerite Hospital 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
| | - Jacquet Christophe
- CNRS, ISM UMR 7287, Aix-Marseille University, 13288, Marseille Cedex 09, France
- Department of Orthopedic Surgery and Traumatology, Institute of Movement and Locomotion, University Institute of Movement and Locomotion, St. Marguerite Hospital 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
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Willinger L, Athwal KK, Holthof S, Imhoff AB, Williams A, Amis AA. Role of the Anterior Cruciate Ligament, Anterolateral Complex, and Lateral Meniscus Posterior Root in Anterolateral Rotatory Knee Instability: A Biomechanical Study. Am J Sports Med 2023; 51:1136-1145. [PMID: 36917838 PMCID: PMC10068405 DOI: 10.1177/03635465231161071] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Injuries to the anterior cruciate ligament (ACL), Kaplan fibers (KFs), anterolateral capsule/ligament (C/ALL), and lateral meniscus posterior root (LMPR) have been separately linked to anterolateral instability. PURPOSE To investigate the contributions of the ACL, KFs, C/ALL, and LMPR to knee stability and to measure instabilities resulting from their injury. STUDY DESIGN Controlled laboratory study. METHODS Ten fresh-frozen human knees were tested robotically to determine restraints of knee laxity at 0° to 90° of flexion. An 88-N anterior-posterior force (anterior and posterior tibial translation), 5-N·m internal-external rotation, and 8-N·m valgus-varus torque were imposed and intact kinematics recorded. The kinematics were replayed after sequentially cutting the structures (order varied) to calculate their contributions to stability. Another 10 knees were tested in a kinematics rig with optical tracking to measure instabilities after sequentially cutting the structures across 0° to 100° of flexion. One- and 2-way repeated-measures analyses of variance with Bonferroni correction were used to find significance (P < .05) for the robotic and kinematics tests. RESULTS The ACL was the primary restraint for anterior tibial translation; other structures were insignificant (<10% contribution). The KFs and C/ALL resisted internal rotation, reaching 44% ± 23% (mean ± SD; P < .01) and 14% ± 13% (P < .05) at 90°. The LMPR resisted valgus but not internal rotation. Anterior tibial translation increased after ACL transection (P < .001) and after cutting the lateral structures from 70° to 100° (P < .05). Pivot-shift loading increased anterolateral rotational instability after ACL transection from 0° to 40° (P < .05) and further after cutting the lateral structures from 0° to 100° (P < .01). CONCLUSION The anterolateral complex acts as a functional unit to provide rotatory stability. The ACL is the primary stabilizer for anterior tibial translation. The KFs are the most important internal rotation restraint >30° of flexion. Combined KFs + C/ALL injury substantially increased anterolateral rotational instability while isolated injury of either did not. LMPR deficiency did not cause significant instability with the ACL intact. CLINICAL RELEVANCE This study is a comprehensive biomechanical sectioning investigation of the knee stability contributions of the ACL, anterolateral complex, and LMPR and the instability after their transection. The ACL is significant in controlling internal rotation only in extension. In flexion, the KFs are dominant, synergistic with the C/ALL. LMPR tear has an insignificant effect with the ACL intact.
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Affiliation(s)
- Lukas Willinger
- Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | | | - Andreas B Imhoff
- Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Forkel P, Noack J, Hinz M, Imhoff AB, Wörtler K, Feucht MJ. Coronal extrusion of the lateral meniscus does not increase after pullout repair of the posterior root of the lateral meniscus at short-term follow-up. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04815-z. [PMID: 36847859 PMCID: PMC10374772 DOI: 10.1007/s00402-023-04815-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Posterior lateral meniscus root (PLMR) tears are injuries that commonly occur together with anterior cruciate ligament (ACL) tears. The aim of this study was to evaluate the clinical and radiological outcome of PLMR repair accompanying ACL reconstruction. Specifically, PLMR healing rates, meniscal extrusion behavior and their influence on patient-reported outcome measures (PROMs) were analyzed. It was hypothesized that PLMR repair shows satisfactory healing rates and coronal meniscal extrusion does not increase significantly following PLMR repair. METHODS Patients that underwent PLMR repair between 2014 and 2019 were evaluated at least 12 months postoperatively. At follow-up, magnetic resonance imaging (MRI) was performed in order to evaluate the PLMR healing behavior (complete vs. partial vs. no healing) as well as the coronal and sagittal meniscal extrusion in comparison with the preoperative MRI. Additionally, patient-reported outcome measures (PROMs; Lysholm score, International Knee Documentation Committee subjective knee form [IKDC]) were compiled. Pre- and postoperative meniscal extrusion were tested for statistical significance using the paired t test. The Kruskal-Wallis test was used to compare extrusion values and PROMs in relation to different healing states. A correlation analysis was conducted using the Pearson correlation coefficient between differences in meniscal extrusion and PROMs. RESULTS Out of 25 patients, 18 patients (72.0%; 11 male and seven female) were available for final assessment at a mean follow-up of 40.8 ± SD 17.5 months. One revision PLMR repair was performed five months after the initial repair. In 14 cases (77.8%), healing of the lateral meniscus was observed (6 × complete, 8 × partial). Coronal extrusion of the lateral meniscus did not increase significantly following PLMR repair (2.0 ± 1.5 mm vs. 2.1 ± 1.3 mm; p = 0.645). Sagittal extrusion increased significantly (25.7 ± 2.4 mm vs. 27.0 ± 1.4 mm; p < 0.001). The healing status of the PLMR showed no significant association with meniscal extrusion or PROMs (p > 0.05). But a higher increase in coronal meniscal extrusion negatively affected PROMs (Lysholm score: p = 0.046, r = - 0.475; IKDC: p = 0.003, r = - 0.651). CONCLUSION High healing rates of the PLMR and no significant increase in coronal extrusion may be expected following combined PLMR repair and ACL reconstruction. But a greater increase in postoperative coronal meniscal extrusion correlates with less favorable clinical results. A greater increase in sagittal extrusion was observed, but this did not influence the clinical outcome. LEVEL OF EVIDENCE Retrospective Case Series; IV.
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Affiliation(s)
- Philipp Forkel
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.,Raphaelsklinik, Münster, Germany
| | - Jonas Noack
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Maximilian Hinz
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Klaus Wörtler
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias J Feucht
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.,Diakonie-Klinikum Stuttgart, Stuttgart, Germany
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Seiter M, Douglass BW, Brady AW, Dornan GJ, Brown JR, Hackett TR. In situ repair of segmental loss posterior lateral meniscal root tears outperforms meniscofemoral ligament imbrication in the ACL reconstructed knee. J Exp Orthop 2023; 10:8. [PMID: 36697992 PMCID: PMC9877254 DOI: 10.1186/s40634-023-00572-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/12/2023] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The purpose of this study was to compare the biomechanical effect of in-situ repair of posterior lateral meniscal root (PLMR) tear with segmental meniscal loss, with and without meniscofemoral ligament (MFL) imbrication, on anterior cruciate ligament (ACL) graft force and knee joint kinematics. METHODS Ten fresh-frozen cadaveric knee specimens underwent kinematic evaluation in five states: 1) Native, 2) ACLR, 3) Segmental PLMR loss, 4) In-situ PLMR repair, and 5) MFL augmentation. Kinematic evaluation consisted of five tests, each performed at full extension and at 30° of flexion: 1) Anterior drawer, 2) Internal Rotation, 3) External Rotation, 4) Varus, and 5) Valgus. Additionally, a simulated pivot shift test was performed. Knee kinematics and ACL graft force were measured. RESULTS PLMR tear did not significantly increase ACL graft force in any test. However, PLMR repair significantly reduced ACL graft force compared to the ACLR alone (over constraint -26.6 N, p = 0.001). PLMR tear significantly increased ATT during the pivot shift test (+ 2.7 mm, p = 0.0001), and PLMR repair restored native laxity. MFL augmentation did not improve the mechanics. CONCLUSIONS In-situ PLMR repair eliminated pivot shift laxity through ATT and reduced force on the ACL graft, indicating that this procedure may be ACL graft-protective. MFL augmentation was not shown to have any effect on graft force or knee kinematics and untreated PLMR tears may place an ACL graft at higher risk. This study suggests concomitant repair to minimize additional forces on the ACL graft.
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Affiliation(s)
- Max Seiter
- grid.419649.70000 0001 0367 5968Steadman Philippon Research Institute, Vail, CO USA
| | - Brenton W. Douglass
- grid.419649.70000 0001 0367 5968Steadman Philippon Research Institute, Vail, CO USA
| | - Alex W. Brady
- grid.419649.70000 0001 0367 5968Steadman Philippon Research Institute, Vail, CO USA
| | - Grant J. Dornan
- grid.419649.70000 0001 0367 5968Steadman Philippon Research Institute, Vail, CO USA
| | - Justin R. Brown
- grid.419649.70000 0001 0367 5968Steadman Philippon Research Institute, Vail, CO USA
| | - Thomas R. Hackett
- grid.419649.70000 0001 0367 5968Steadman Philippon Research Institute, Vail, CO USA
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19
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Szalay A, Runer A, Ehmann Y, Imhoff AB, Mehl J, Achtnich A. Kindliche vordere Kreuzbandruptur mit komplexer Außenmeniskusverletzung und Knorpelfragmentablösung der posterolateralen Tibia. ARTHROSKOPIE 2023. [DOI: 10.1007/s00142-022-00587-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
ZusammenfassungEin 11-jähriger Junge erleidet ein Distorsionstrauma des Kniegelenks mit einer Ruptur des vorderen Kreuzbands (VKB), Läsion des Außenmeniskus und Ablösung eines Knorpelfragments am posterolateralen Tibiaplateau. Aufgrund der konträren Nachbehandlungsschemata dieser schwerwiegenden Kombinationsverletzung erfolgt eine zweizeitige operative Versorgung. In einem ersten arthroskopischen Eingriff werden die Meniskus- und Knorpelverletzung behandelt. Nach stattgefundener Knorpeleinheilung erfolgt eine epiphysenschonende Rekonstruktion des vorderen Kreuzbands.
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20
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Author Reply: "H-Plasty Repair Technique Improved Tibiofemoral Contact Mechanics After Repair for Adjacent Radial Tears of Posterior Lateral Meniscus Root: A Biomechanical Study". Arthroscopy 2023; 39:1126-1127. [PMID: 36646361 DOI: 10.1016/j.arthro.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
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21
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Karpinski K, Forkel P, Häner M, Bierke S, Petersen W. Etiology of posterior meniscus root tears: medial vs. lateral. Arch Orthop Trauma Surg 2023; 143:429-437. [PMID: 35076768 DOI: 10.1007/s00402-022-04347-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/04/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to generate more information on the etiology and pathogenesis of medial (MM) and lateral (LM) meniscus root tears. Our hypothesis was that root tears of the MM predominantly result from degenerative damage, whereas root injuries of the LM are mainly of traumatic origin. METHODS Consecutively, 53 patients with a root tear of the medial meniscus (MMRT) and 51 patients with a root tear of the lateral meniscus (LMRT) were included in this study. The diagnosis was confirmed radiologically by MRI as well as arthroscopically. In addition to patient-specific data such as age, BMI and trauma history, the leg axis was determined and accompanying injuries (ligamentous and chondrogenic) were documented. RESULTS The mean age of the MMRT group was 57.2 (± 11.2) years, and that of the LMRT group 33.9 (± 11.4) years. The BMI was significantly higher in the MMRT group compared to the LMRT (30.5 vs. 25.1). 82.4% of patients in the LMRT group demonstrated an accompanying anterior cruciate ligament (ACL) rupture, whereas only 5.7% of the MMRT were associated with an ACL injury. A trauma was described in only 13.2% of patients of the MMRT group in contrast to 88.2% of the LMRT group. An extrusion > 3 mm of the MM in the coronal plane of MRI images could be detected in 86.8% of patients, whereas in the LMRT group, it was 15.7%. The mechanical varus angle was 5.6° in the MMRT group and 2.4° in the LMRT group. The rate and degree of concomitant cartilage damage in the affected compartment was significantly higher in the group with medial root injuries than in the group with lateral root tears. CONCLUSIONS The root injuries of the MM and LM show significant differences in terms of patient age, etiology and accompanying injuries. Root injuries to the medial meniscus are mostly of non-traumatic origin and more likely to occur in the context of medial osteoarthritis and varus deformity of the knee. Lateral root tears tend to be predominantly traumatic and are frequently associated with ACL ruptures. However, in the MMRT group, a small subgroup with a traumatic etiology and in the LMRT group a small subgroup of patients with non-traumatic etiology could be identified. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Katrin Karpinski
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar-Theyss-Strasse 27-31, 14193, Berlin, Germany
| | - Philipp Forkel
- Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Martin Häner
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar-Theyss-Strasse 27-31, 14193, Berlin, Germany
| | - Sebastian Bierke
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar-Theyss-Strasse 27-31, 14193, Berlin, Germany
| | - Wolf Petersen
- Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar-Theyss-Strasse 27-31, 14193, Berlin, Germany.
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22
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Zhang S, Chen G, Li R, Yang C, Zheng J, Wang C, Lu J, Zhang Z, Shang X, Zhang H, Wang W, Li W, Huang J, Zhang Y, Wang J, Wang Y, Zheng X, Chen S, Li J, Hua Y. Guidelines on the Diagnosis and Treatment of Lateral Meniscal Lesions: A Consensus Statement by the Chinese Society of Sports Medicine. Orthop J Sports Med 2022; 10:23259671221138082. [PMID: 36532151 PMCID: PMC9747892 DOI: 10.1177/23259671221138082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/26/2022] [Indexed: 05/07/2025] Open
Abstract
BACKGROUND The lateral meniscus is a unique structure of the knee joint, and its anatomy, function, pathological process, and treatment are distinct from those of the medial meniscus. To date, no consensus on the management of lateral meniscal lesions has been published, and clinical decision-making is challenging. To facilitate this, consensus and practice guidelines for lateral meniscal lesions were developed and endorsed by the Chinese Society of Sports Medicine. STUDY DESIGN Consensus statement. METHODS This project followed the Delphi approach to the consensus process, involving steering, rating, and peer review groups. A total of 61 experts in the fields of sports medicine and arthroscopic surgery were invited to participate in the compilation of a consensus statement on lateral meniscal lesions. (The discoid lateral meniscus was addressed by separate consensus.) To begin, the steering group drafted a set of questions and replies regarding lateral meniscal lesions. An online panel discussion was then held to provide initial agreement and comments on the statements, followed by a round of anonymous voting. Results and feedback were sent to the steering group for a second draft. A second round of voting was then held, and each statement was discussed during a combined meeting of the steering and rating groups. Finally, a consensus draft was evaluated by a review group. RESULTS Fifty-three questions and answers addressing lateral meniscal lesions were drafted, and 20 statements were excluded because of redundant information during the first round of voting. Ultimately, 33 statements were completed, 9 of which were unanimous. CONCLUSION This expert consensus process focused on the anatomy, function, pathological processes, and treatment of lateral meniscal lesions. Accepted recommendations in these areas can assist doctors and therapists in standardizing the management of related pathology. The consensus statement indicates that certain types of lateral meniscal tears that were previously considered irreparable can be repaired. Preservation of the lateral meniscus should be the first-line treatment whenever possible, because the long-term clinical and radiological outcomes are worse after partial meniscectomy.
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Affiliation(s)
- Shurong Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Gang Chen
- Orthopaedic Research Institution, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Ruixin Li
- Department of Sports Medicine, Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning Province, China
| | - Chunxi Yang
- Department of Bone and Joint Surgery, Department of Orthopaedics, Shanghai Jiaotong University, School of Medicine, Renji Hospital, Shanghai, China
| | - Jiapeng Zheng
- Department of Orthopaedic Surgery, Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Fujian Province, China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jun Lu
- Department of Orthopaedic Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, China
| | - Zhengzheng Zhang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Province, China
| | - Xiliang Shang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hui Zhang
- Sports Medicine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Weiming Wang
- Department of Sports Medicine, Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning Province, China
| | - Weiping Li
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Province, China
| | - Jingmin Huang
- Department of Sports Injuries and Arthroscopy, Tianjin Hospital, Tianjin, China
| | - Yadong Zhang
- Department of Orthopaedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Jianquan Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - You Wang
- Department of Bone and Joint Surgery, Department of Orthopaedics, Shanghai Jiaotong University, School of Medicine, Renji Hospital, Shanghai, China
| | - Xiaofei Zheng
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Shiyi Chen
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Jian Li
- Orthopaedic Research Institution, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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23
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LaPrade RF, Geeslin AG, Chahla J, Cohen M, Engebretsen L, Faucett SC, Getgood AM, Inderhaug E, Johnson DL, Kopf S, Krych AJ, Larson CM, Lind M, Moatshe G, Murray IR, Musahl V, Negrin R, Riboh JC, Seil R, Spalding T. Posterior Lateral Meniscal Root and Oblique Radial Tears: The Biomechanical Evidence Supports Repair of These Tears, Although Long-Term Clinical Studies Are Necessary. Arthroscopy 2022; 38:3095-3101. [PMID: 36462774 DOI: 10.1016/j.arthro.2022.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/28/2022] [Indexed: 12/03/2022]
Affiliation(s)
| | - Andrew G Geeslin
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | | | - Moises Cohen
- Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Alan M Getgood
- Fowler Kennedy Sports Medicine Clinic, London, Ontario, Canada
| | | | | | | | | | | | | | | | - Iain R Murray
- Edinburgh Orthopaedics, The University of Edinburgh, Edinburgh, UK
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center Pittsburgh, Pennsylvania, USA
| | | | - Jonathan C Riboh
- Orthocarolina and Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Romain Seil
- Sports Clinic, Centre Hospitalier de Luxembourg - Clinique d'Eich, Luxembourg, Luxenbourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg
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24
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Jeon YS, Alsomali K, Yang SW, Lee OJ, Kang B, Wang JH. Posterior Horn Lateral Meniscal Oblique Radial Tear in Acute Anterior Cruciate Ligament Reconstruction Incidence and Outcomes After All-Inside Repair: Clinical and Second-Look Arthroscopic Evaluation. Am J Sports Med 2022; 50:3796-3804. [PMID: 36322384 DOI: 10.1177/03635465221126506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The term posterior horn lateral meniscal oblique radial tear (LMORT) has emerged to characterize the tear patterns of the lateral meniscus in many patients with acute anterior cruciate ligament (ACL) injury. There is a lack of data regarding the exact incidence according to the types of LMORT and clinical outcomes. PURPOSES (1) To investigate the incidence of LMORT according to type in patients with acute ACL reconstruction (ACLR) and (2) to identify healing status after repair of LMORT via second-look arthroscopy and clinical outcomes. STUDY DESIGN Case series; Level of evidence: 4. METHODS Patients who underwent primary ACLR within 6 months of injury were retrospectively reviewed. The LMORT was classified into 4 types based on the severity and distance from the root: type 1 (partial tear <10 mm from the root), type 2 (complete tear <10 mm from the root), type 3 (partial tear >10 mm from the root), type 4a (complete tear >10 mm from the root), and type 4b (type 4a with longitudinal tear at the meniscocapsular junction). Only patients with LMORT were isolated, and the clinical outcomes were compared according to the healing status of LMORT in second-look arthroscopy. RESULTS Of 635 patients with ACLR, LMORT was identified in 97 patients (15.3%), and type 4 LMORT accounted for the largest proportion (n = 62; 32.6%) of 190 lateral meniscal tears. In 79 patients with LMORT who satisfied the 2-year follow-up period, all patient-reported outcomes (PROs), including the Lysholm (preoperative, 64.1; postoperative, 88.2) and International Knee Documentation Committee subjective (preoperative, 50.5; postoperative, 82.9) scores, were significantly improved (P < .001) 31.8 months postoperatively. Of the 61 patients who underwent second-look arthroscopy, 49 (80.3%) were classified into the complete healing group. There was no significant difference in postoperative PROs between the complete and partial healing groups. CONCLUSION The incidence of LMORT was 15.3% in patients with acute ACL injury, and type 4 LMORT was the most common type. Complete healing of LMORT was achieved in 80.3% of patients who underwent second-look arthroscopy, and the PROs were significantly improved postoperatively. Good clinical results can be achieved if the LMORT is repaired as much as possible during ACLR.
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Affiliation(s)
- Young-Sik Jeon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Khalid Alsomali
- Department of Orthopedic Surgery, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Seong Wook Yang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Oei Jong Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Byoungyoul Kang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Gangnam-gu, Seoul, Republic of Korea
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25
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Transtibial Pullout Repair of Lateral Meniscus Posterior Root Tear with Tissue Loss: A Case with Anterior Cruciate Ligament Injury and Medial Meniscus Tear. Case Rep Orthop 2022; 2022:9776388. [PMID: 36092283 PMCID: PMC9453023 DOI: 10.1155/2022/9776388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/21/2022] [Accepted: 08/11/2022] [Indexed: 11/18/2022] Open
Abstract
Lateral meniscus (LM) posterior root tear (LMPRT) is mainly caused by trauma, especially trauma associated with anterior cruciate ligament (ACL) injuries. Although a transtibial pullout repair or a side-to-side repair is commonly performed for LMPRT, to the best of our knowledge, there is no clinical report of LMPRT with tissue loss using the pullout technique. Thus, the purpose of this report was to describe a clinical, radiographic, and arthroscopic outcome after pullout repair for a case of LMPRT with a large defect with a chronic ACL tear and complex medial meniscus (MM) tears. A 31-year-old man complained of knee pain and restricted range of motion after twisting his knee when he stepped on an iron pipe. The patient had a football-related injury to his right knee 14 years before presentation, and since then, the patient's knee has given out more than 10 times but was left unassessed. Magnetic resonance imaging showed LMPRT with tissue loss, ACL tears, and complex MM tears. Transtibial pullout repair of the LMPRT with ACL reconstruction and MM repairs were performed. Following the pullout repair of the LMPRT, an approximately 6 mm gap remained between the LM posterior root and root insertion. However, magnetic resonance imaging and second-look arthroscopy at 1 year postoperatively revealed meniscal healing, gap filling with some regeneration tissue, of the LM posterior root. Furthermore, the lateral meniscus extrusion in the coronal plane improved from 3.1 mm (preoperative) to 1.6 mm (1 year postoperatively). Transtibial pullout repair with the remaining gap could be a viable treatment option for LMPRT with tissue loss, combined with ACL reconstruction.
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26
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Li M, Li Z, Li Z, Jiang H, Lee S, Huang W, Zheng Q. Transtibial pull-out repair of lateral meniscus posterior root is beneficial for graft maturation after anterior cruciate ligament reconstruction: a retrospective study. BMC Musculoskelet Disord 2022; 23:445. [PMID: 35549693 PMCID: PMC9097100 DOI: 10.1186/s12891-022-05406-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To determine the repair of LMPR lesions would improve the ACL graft maturation. METHOD A total of 49 patients underwent ACL reconstruction were included in this study. Patients were furtherly sub-grouped according to the status of LMPR: intact (17), repair (16) and resected (16). Assessments performed pre- and 2 years post-operatively included patients-reported scores and arthrometer side-to-side difference. Magnetic resonance imaging was used 2 years after the surgery to compare the lateral meniscal extrusion (LME), anterior tibial subluxation of the medial compartment (ATSMC), anterior tibial subluxation of the lateral compartment (ATSLC), the difference of ATSMC and ATSLC, and signal/noise quotient (SNQ) of ACL graft. RESULTS In LMPR resected group, it showed greater post-operative ATSMC-ATSLC difference when compared with pre-operatively (P = 0.006) and with the other 2 groups (intact: P = 0.031; repair: P = 0.048). SNQ of ACL graft was higher in LMPR resected group than those in LMPR intact (P = 0.004) and repair group (P = 0.002). The LMPR repair group showed significant reduction in LME post-operatively (P = 0.001). Post-operative measures on ATSLC-ATSMC difference (β = 0.304, P = 0.049) and LME (β = 0.492, P = 0.003) showed significant association with graft SNQ. CONCLUSIONS Transtibial repair of LMPR concomitant with ACL reconstruction restored translational stability, reduced meniscus extrusion, making it beneficial for ACL graft maturation.
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Affiliation(s)
- Mengyuan Li
- Division of Joint Osteopathy and Traumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Zeng Li
- Division of Joint Osteopathy and Traumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Zezhen Li
- Division of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Hai Jiang
- Division of Joint Osteopathy and Traumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Soomin Lee
- Division of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Wenhan Huang
- Division of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China.
| | - Qiujian Zheng
- Division of Joint Osteopathy and Traumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China.
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27
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Ozeki N, Koga H, Sekiya I. Degenerative Meniscus in Knee Osteoarthritis: From Pathology to Treatment. Life (Basel) 2022; 12:603. [PMID: 35455094 PMCID: PMC9032096 DOI: 10.3390/life12040603] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/31/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022] Open
Abstract
Knee osteoarthritis is a common degenerative joint disease characterized by chronic knee pain and disability in daily living. The lesion can involve the cartilage as well as the synovium, bone, ligaments, and meniscus, indicating a complicated pathology for knee osteoarthritis. The association with the meniscus has recently attracted much attention. Meniscal tears can initiate and progress knee osteoarthritis, with deleterious effects on the important roles of the meniscus in load distribution, shock absorption, and stability of the knee joint. Degenerative meniscus lesions are commonly observed in elderly people, but they have less impact on the prognosis of osteoarthritis. However, they are often accompanied by meniscal extrusion, which substantially decreases the hoop function of the meniscus and increases the risk of knee osteoarthritis. When surgical treatment is necessary, meniscal tears should be repaired to the greatest extent possible to preserve meniscus function. Long-term studies show better clinical outcomes and less degenerative osteoarthritis changes following meniscal repair than following partial meniscectomy. For meniscal extrusion repair, centralization techniques have been proposed that involve suturing the meniscus-capsule complex to the edge of the tibial plateau. Advancements in orthobiologics, such as platelet-rich plasma or stem cell therapy, have the potential to prevent the initiation or progression of osteoarthritis.
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Affiliation(s)
- Nobutake Ozeki
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan;
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan;
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan;
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Gursoy S, Perry AK, Brady A, Dandu N, Singh H, Vadhera AS, Yanke AB, LaPrade RF, Chahla J. Optimal Tibial Tunnel Placement for Medial and Lateral Meniscus Root Repair on the Anteromedial Tibia in the Setting of Anterior and Posterior Cruciate Ligament Reconstruction of the Knee. Am J Sports Med 2022; 50:1237-1244. [PMID: 35225000 DOI: 10.1177/03635465221074312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although the risk of tibial tunnel convergence in the setting of multiligamentous reconstruction has been reported in the literature, the risk of tunnel convergence in the setting of posterior cruciate ligament (PCL), anterior cruciate ligament (ACL) reconstruction and medial and lateral meniscus root repair has not been defined. PURPOSE To examine the risk of tunnel convergence and to determine optimal tunnel placement for ACL and PCL reconstruction performed in conjunction with posterior medial and lateral meniscus root repairs on the anteromedial proximal tibia. STUDY DESIGN Descriptive laboratory study. METHODS Three-dimensional (3D) tibial models were created using computed tomography scans of 20 cadaveric specimens. After determining optimal tunnel entry and exit points for ACL and PCL reconstructions, and medial and lateral meniscus root reattachment to the anatomic footprints, we used image processing software to create root tunnels over the anteromedial tibia on the tibial models. ACL and PCL tunnels were kept constant. The meniscus root repair tunnels were then reoriented to match the angle of the ACL tunnel, making both tunnels parallel in the sagittal plane. Tunnel convergence risk was analyzed by identifying the shortest 3D distance between tunnel axes and subtracting the radius of each tunnel from this distance for single- and double-tunnel repair techniques in both case scenarios. RESULTS All specimens demonstrated convergence between the ACL and lateral meniscus root tunnels when the root tunnel's entry was created proximal to the ACL tunnel's entry for single- and double-tunnel techniques, but no convergence was seen between these tunnels using the parallel orientation in the sagittal plane. There were no cases of convergence between the ACL and medial meniscus root tunnels in any of the configurations. The greatest distance between the ACL and medial meniscus root tunnels was achieved using the single-tunnel technique in parallel orientation (12.1 ± 2.8 mm). There were no cases of convergence between the PCL and medial meniscus root tunnels in the original orientation; however, 2 of 20 specimens demonstrated convergence using the parallel orientation with the double-tunnel technique, and there were no cases of convergence using the single-tunnel technique. The PCL and lateral meniscus root tunnels did not demonstrate convergence in any configuration. CONCLUSION There was a high risk of convergence between ACL and posterior meniscus root tunnels when all the tunnels were created on the anteromedial tibia. Reorienting meniscus root tunnels parallel to ACL tunnels may help reduce this risk. There is increased risk of tunnel convergence with root repairs in cases of bicruciate reconstructions, and therefore a double-tunnel root repair technique should be used with caution. CLINICAL RELEVANCE To avoid tibial tunnel convergence when performing ACL and PCL reconstruction with medial and lateral meniscus root repair, surgeons should reorient the meniscus root repair tunnels to be parallel on the sagittal plane to the ACL tunnel to decrease the risk of convergence. In cases of bicruciate ligament reconstruction, use of the double-tunnel technique requires caution to avoid convergence risk with the PCL tunnel.
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Affiliation(s)
- Safa Gursoy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Allison K Perry
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Alex Brady
- Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA
| | - Navya Dandu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Harsh Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Amar S Vadhera
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B Yanke
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Shekhar A, Tapasvi S, Williams A. Outcomes of Combined Lateral Meniscus Posterior Root Repair and Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671221083318. [PMID: 35299712 PMCID: PMC8921756 DOI: 10.1177/23259671221083318] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/08/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Lateral meniscus posterior root tears (LMPRTs) almost always occur in association with anterior cruciate ligament (ACL) tears. Their repair is advocated to restore the stabilizing and load-sharing functions of the meniscus. Purpose: To study the functional outcomes of combined arthroscopic repair of LMPRTs and ACL reconstruction (ACLR). Study Design: Case series; Level of evidence, 4. Methods: The authors evaluated patients who underwent simultaneous arthroscopic ACLR and LMPRT repair. All patients had chronic injuries, with a mean time since ACL rupture of 7.9 months. Patient characteristics, Lachman and pivot-shift test results, type of LMPRT, associated injuries, and surgery details were documented. Pre- and postoperative functional status was assessed using the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. An independent single-tunnel transtibial repair using 2 SutureTapes was performed for Forkel type 1 and 3 tear root avulsions, while side-to-side suture repair was performed for type 2 radial/oblique tears. The Wilcoxon signed rank test and minimal clinically important difference (MCID) of the IKDC score were used for statistical analysis. Results: Included were 25 patients with a mean age of 29.6 ± 6.5 years. Of these, 22 patients (88%; 95% CI, 73.1%-100%) had a high-grade (grade 2 or 3) preoperative pivot shift. Diagnosis of the LMPRT on magnetic resonance imaging (MRI) scans was possible only in 5 patients (20%). At final evaluation, performed at 37.4 ± 7.1 months postoperatively, all functional scores had improved significantly from preoperatively: IKDC score, from 47.6 ± 9.5 to 81.8 ± 11.5; KOOS, from 45.5 ± 10.9 to 86.5 ± 10.3, and Lysholm score, from 49.0 ± 11.5 to 88.8 ± 7.6 (P < .001 for all). Twenty-four patients (96%) achieved the MCID for the IKDC score. All knees had a negative pivot shift at final analysis, and no patient underwent revision ACLR or LMPRT repair. Conclusion: LMPRT repair combined with ACLR led to good short-term clinical outcomes in this study. An LMPRT may frequently go undetected on preoperative MRI scans, but a high-grade pivot shift is present in a large majority of these patients.
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Kim JN, Park HJ, Kim MS, Won SY, Kim M, Park JH, Kim E, Park JY. Prevalence of anterolateral ligament injuries and lateral meniscus tear on MR imaging in patients with both-bundle tear vs. selective bundle incomplete tear of the anterior cruciate ligament. Eur Radiol 2022; 32:3954-3962. [PMID: 35020013 DOI: 10.1007/s00330-021-08472-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We investigated the prevalence of anterolateral ligament (ALL) injury and lateral meniscus (LM) tear in cases with both-bundle tear and selective bundle incomplete tear of the anterior cruciate ligament (ACL). METHODS A total of 174 cases of magnetic resonance (MR) images that had an ACL tear and underwent arthroscopic ACL reconstruction were retrospectively reviewed. ACL injury was classified into both bundle, anteromedial bundle, and posterolateral bundle (PL) on arthroscopic finding. The ALL was divided into three portions: femoral, meniscal, and tibial. ALL injury was scored into three groups: grade 0 is intact; grade 1 is stranding and edema surrounds the expected location of the ALL; grade 2 is clear discontinuity of the ALL consistent with rupture. Traumatic LM tear was also assessed on MR images. RESULTS The total prevalence of ALL injury was 36.2% (reader 1) and 42.0% (reader 2). ALL injury was statistically related to the selective bundle tear (p = 0.002 and 0.004, readers 1 and 2). PL bundle tear was significantly correlated with the ALL injury (p value < 0.001, readers 1 and 2, both). The location and grade of ALL injury were not significantly correlated with the type of ACL injury. LM tear was not significantly related to the types of ACL tear (p = 0.208 and 0.907, readers 1 and 2) and ALL injury (p value = 0.096 and 0.383, readers 1 and 2). CONCLUSIONS ALL injury was significantly related to the PL bundle tear of the ACL. LM tear was not significantly correlated with the types of ACL injury and ALL injury. KEY POINTS • Anterolateral ligament (ALL) injury was significantly related to the posterolateral bundle (PL) tear of the anterior cruciate ligament (ACL). • Lateral meniscus (LM) tear was not significantly correlated with the types of ACL injury and ALL injury. • Clinicians and radiologists should be aware of these relationships and scrutinize ALL injury in cases with PL bundle tears, even with an incomplete ACL injury.
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Affiliation(s)
- Ji Na Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea.
| | - Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea
| | - So Yeon Won
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Minchul Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Jai Hyung Park
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eugene Kim
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Yeon Park
- Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, Gyeonggido, Republic of Korea
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Jacquet C, Mouton C, Magosch A, Komnos GA, Menetrey J, Ollivier M, Seil R. The aspiration test reveals an instability of the posterior horn of the lateral meniscus in almost one-third of ACL-injured patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:2329-2335. [PMID: 34839369 PMCID: PMC9206618 DOI: 10.1007/s00167-021-06806-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/11/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injuries often lead to associated injuries of the posterior horn of the lateral meniscus (PHLM). Arthroscopic, assessment of PHLM instability may be difficult in the absence of a visible meniscus damage. The main objective of this prospective multi-center study was to compare the ability of the probing and aspiration tests to identify PHLM instability in a population of patients undergoing ACL reconstruction (ACLR) and a control group of patients with an intact ACL undergoing knee arthroscopy. METHODS A prospective case-control analysis was performed in three sports medicine centers. One-hundred and three consecutive patients operated for a primary isolated ACLR without structural lateral meniscus damage other than a root tear were included. They were compared to a control group of 29 consecutive patients who had a knee arthroscopy with an intact ACL and no structural lateral meniscus lesion. The probing and aspiration tests were consecutively executed according to previously published methods. RESULTS In the control group, no lateral meniscus lesions were visualized during arthroscopy, and both probing and aspiration tests were negative in all patients. In the group of ACL-injured patients, a Forkel type I-III posterolateral meniscus root tear (PLMRT) was found in 12 patients (12%). In this subgroup, the probing test was positive in 4/12 patients (33%) and the aspiration test in 5 additional patients (75%). In 15 patients (15%), an elongation of the posterior root of the lateral meniscus (defined as type IV PLMRT as an addendum to the Forkel classification) could be observed during arthroscopy. In this subgroup, only 1 patient displayed a PHLM instability with the probing test (7%), whereas the aspiration test was positive in 13/15 patients (87%). In the remaining 76 patients (74%), no structural lesion of the PHLM could be identified. Nevertheless, an instability of the PHLM could be identified in 8 of them (11%) with the probing test, and the aspiration test was positive in 2 additional knees (13%) of this apparently normal subgroup. Altogether, in the entire ACL injury cohort, a positive probing test was observed in 13/103 patients (13%) and a positive aspiration test in 32/103 knees (31%) (p < 0.01). CONCLUSION Careful observation and examination of the PHLM with the aspiration test revealed a substantial amount of previously undiagnosed lateral meniscus instabilities in ACL-injured knees. The prevalence of PHLM instability as evaluated by the aspiration test was high (31%). The aspiration test was superior to the probing test in detecting an instability of the PHLM in a population of ACL-injured patients. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Christophe Jacquet
- Department of Orthopedic Surgery and Traumatology, Institute for Movement and Locomotion (IML), St. Marguerite Hospital, Marseille, France
| | - Caroline Mouton
- Sports Clinic, Centre Hospitalier de Luxembourg, Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Amanda Magosch
- Sports Clinic, Centre Hospitalier de Luxembourg, Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg
| | - George A Komnos
- Centre de Medecine du Sport et de l'Exercice, Swiss Olympic Medical Center, Hirslanden Clinique la Colline, Geneva, Switzerland
| | - Jacques Menetrey
- Centre de Medecine du Sport et de l'Exercice, Swiss Olympic Medical Center, Hirslanden Clinique la Colline, Geneva, Switzerland
- Service de Chirurgie Orthopédique, University Hospital of Geneva, Geneva, Switzerland
| | - Matthieu Ollivier
- Department of Orthopedic Surgery and Traumatology, Institute for Movement and Locomotion (IML), St. Marguerite Hospital, Marseille, France
| | - Romain Seil
- Sports Clinic, Centre Hospitalier de Luxembourg, Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg.
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg.
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg, Luxembourg.
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Cengiz B, Karaoglu S. Case report of concomitant avulsion fractures of the medial meniscus and posterior cruciate ligament. Medicine (Baltimore) 2021; 100:e28273. [PMID: 34918701 PMCID: PMC8677961 DOI: 10.1097/md.0000000000028273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Posterior cruciate ligament (PCL) is the strongest ligament of the knee, and avulsion fractures of PCL are a very rare type of injury. These injuries occur as a result of high-energy traumas, and different accompanying pathologies may be seen. However, tibial avulsion fracture of the PCL associated with a medial meniscus (MM) avulsion fracture has never been reported before. We want to present this unique type of posteromedial knee injury as a case report. PATIENT CONCERN A 42-year-old man presented with severe pain and swelling due to a ski injury. DIAGNOSIS Concomitant avulsion fractures of PCL and MM were detected after imaging. INTERVENTIONS Both avulsion fractures were treated with open reduction and fixation with lag screws using the posterior approach. OUTCOMES No complications were encountered, and the painless full range of motion and weight-bearing was achieved at the third month after the operation. LESSONS Anatomical reduction and stable fixation of these intra-articular fractures are essential for the stability of the knee. The posterior approach should be kept in mind to access these types of fractures safely. Care should be taken in terms of other injuries that may accompany the PCL avulsion fractures caused by high-energy traumas.
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Smith PA, Bezold WA, Cook CR, Krych AJ, Stuart MJ, Wijdicks C, Cook JL. Kinematic Analysis of Lateral Meniscal Oblique Radial Tears in the Anterior Cruciate Ligament-Deficient Knee. Am J Sports Med 2021; 49:3898-3905. [PMID: 34699272 DOI: 10.1177/03635465211052521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lateral meniscal oblique radial tears (LMORT) occur frequently in conjunction with anterior cruciate ligament (ACL) disruption and are anatomically distinct from meniscus root tears. HYPOTHESIS/PURPOSE The purpose of this study was to characterize the effects of LMORT types 3 (LMORT3) and 4 (LMORT4) lesions on joint stability and meniscal extrusion in ACL-deficient knees. Our hypothesis was that both lesions would promote significant increases in anterior translation and meniscal extrusion, with the LMORT4 lesion having a greater effect. STUDY DESIGN Controlled laboratory study. METHODS Two matched pairs of cadaveric knees (n = 4) were used to optimize the testing sequence. Additional cadaveric knees with LMORT3 (n = 8) and LMORT4 (n = 8) lesions created after ACL transection underwent robotic kinematic testing for anterior drawer and pivot-shift simulations with associated ultrasound-measured meniscal extrusion at clinically relevant knee flexion angles. RESULTS Optimization testing showed no differences on the effect of LMORT4 lesions for anterior translation and lateral meniscal extrusion with ACL-intact versus ACL-deficient knees. ACL deficiency and LMORT3 and LMORT4 lesions with ACL deficiency were associated with significantly greater anterior translation compared with ACL-intact state for both anterior drawer and pivot-shift testing at all flexion angles (P < .001). ACL deficiency with either LMORT3 or LMORT4 lesion was associated with significantly greater anterior translation than was ACL deficiency only (P < .005) for anterior drawer testing at 90° of flexion. Meniscal extrusion was greater with LMORT3 and LMORT4 lesions compared with ACL deficiency only (P < .05) for anterior drawer at 60° of flexion and for pivot shift at 15° of flexion. The LMORT4 lesion demonstrated increased anterior translation for anterior drawer (P = .003) at 60° of flexion (12%) as well as for pivot shift at 15° of flexion (7%) and 30° of flexion (13%) (P < .005) compared with ACL deficiency only. CONCLUSION In this cadaveric model, the addition of an LMORT3 or LMORT4 lesion increased anterior laxity for both the anterior drawer and the pivot shift when compared with an isolated ACL tear. Lateral meniscal extrusion was also exacerbated by these LMORT lesions. CLINICAL RELEVANCE LMORT lesions, distinct from meniscus root tears, occur frequently in conjunction with ACL tears. This study characterized the biomechanical consequences of LMORT3 and LMORT4 lesions on joint stability and meniscal function, highlighting the importance of diagnosing and treating LMORT lesions at the time of ACL reconstruction.
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Affiliation(s)
| | - Will A Bezold
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
| | - Cristi R Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
| | - Aaron J Krych
- Department of Orthopaedic Surgery, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopaedic Surgery, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | | | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
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Balke M, Metzlaff S, Faber S, Niethammer T, Roessler PP, Henkelmann R, Diermeier T, Kurme A, Winkler PW, Colcuc S, Zimmermann GR, Petersen W. [Posterior meniscus root tears]. DER ORTHOPADE 2021; 50:1039-1050. [PMID: 34767042 DOI: 10.1007/s00132-021-04192-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Meniscus root tears are radial tears in the region of the posterior insertion zones. Medial root injuries usually occur in individuals > 50 years of age without adequate trauma and are associated with obesity and varus deformities. The root lesion leads to a loss of ring tension, which results in extrusion of the meniscus and a strong increase in joint pressure that is biomechanically equivalent to a complete meniscectomy. When indicating arthroscopic transosseous refixation of the medial root lesion, factors such as accompanying cartilage damage, osteoarthritis, obesity and varus deformity must be taken into account. Injuries to the root of the lateral meniscus are mostly observed in younger patients in combination with a rupture of the anterior cruciate ligament. Arthroscopic transosseous refixation in combination with cruciate ligament surgery is therefore also recommended for type I and type II lesions. In summary, both the medial and the lateral root lesions of the menisci are injuries with high biomechanical relevance.
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Affiliation(s)
- Maurice Balke
- Sportsclinic Cologne, Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland.
| | | | - Svea Faber
- OCM - Orthopädische Chirurgie München, München, Deutschland
| | - Thomas Niethammer
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum, Universität München, München, Deutschland
| | - Philip P Roessler
- Gelenkzentrum Mittelrhein | Koblenz, Andernach, Mayen, Andernach, Deutschland
| | - Ralf Henkelmann
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | | | | | - Philipp W Winkler
- Klinikum rechts der Isar, TU (Technische Universität) München, München, Deutschland
| | - Sebastian Colcuc
- Klinik für Arthroskopische Chirurgie, Sporttraumatologie und Sportmedizin, BG (Berufsgenossenschaftliches) Klinikum Duisburg, Duisburg, Deutschland
| | - Ge Rald Zimmermann
- Unfallchirurgie und Sporttraumatologie, Theresienkrankenhaus Mannheim, Mannheim, Deutschland
| | - Wolf Petersen
- Sportklinik Berlin und Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus, Berlin, Deutschland
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Radiological Comparison of Meniscofemoral Ligaments in Patients with Intact and Ruptured Anterior Cruciate Ligament. Asian J Sports Med 2021. [DOI: 10.5812/asjsm.108487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Evaluating concomitant injury in patients with anterior cruciate ligament (ACL) rupture is important for predicting long-term results. Meniscofemoral ligament (MFL) rupture has been observed in patients with anterior cruciate ligament rupture in arthroscopic evaluation for ruptured ACL. Objectives: The objective of this study was to investigate the concomitant meniscofemoral ligaments injury in patients with anterior cruciate ligament ruptures via magnetic resonance imaging (MRI). Methods: A total of 200 patients (with ruptured ACL, n = 100; with intact ACL, n = 100) were retrospectively evaluated via MRI. In the group with ruptured ACL; the patients who were diagnosed as having noncontact ACL injuries and had undergone primary ACL reconstructions were included. The control group included 100 patients with suspected ACL rupture (from a similar injury mechanism) and whose MRI revealed an intact ACL. In the group with ruptured ACL, the time from injury to MRI was evaluated. A comparison of the presence of anterior MFL (aMFL) and posterior MFL (pMFL) between the two groups was evaluated. Results: In the ACL ruptured group, a significantly lower presence of aMFL or pMFL was observed compared to the control group (P = 0.001). The time from injury to MRI was significantly higher in the patients with absent MFL defined in MRI relative to the other groups (P = 0.001). Conclusions: We observed absence of MFLs (aMFL and pMFL) in a significant majority of patients with ruptured ACLs. Furthermore, we found a significant relationship between the time from injury to MRI and absence of MFL in the ruptured ACL group.
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Magosch A, Mouton C, Nührenbörger C, Seil R. Medial meniscus ramp and lateral meniscus posterior root lesions are present in more than a third of primary and revision ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 2021; 29:3059-3067. [PMID: 33165632 DOI: 10.1007/s00167-020-06352-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/26/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of this study was (1) to describe the meniscus tear pattern in anterior cruciate ligament (ACL)-injured patients, with a special focus on medial meniscus (MM) ramp lesions and lateral meniscus (LM) root tears and (2) to determine whether patient and injury characteristics were associated with meniscus tear patterns. METHODS Data from 358 cases of ACL primary and revision reconstruction surgeries were extracted from a center-based registry. During arthroscopy, the presence of associated meniscus lesions was documented by systematically inspecting the anterior and posterior tibiofemoral compartments. With a special focus on MM ramp lesions and LM root tears, groups of different injury tear patterns were formed. Chi-square tests were used to determine whether these groups differed with respect to various patient and injury characteristics, including gender, previous ipsilateral ACL injuries, the injury's relation to sport, person contact during injury and the type of ACL tear. Median age at surgery and body mass index were compared between groups using the Kruskal-Wallis test. Significance was set at p < 0.05. RESULTS Two hundred and thirty-nine ACL injuries (67%) showed additional meniscal injuries, of which 125 (52%) involved the MM ramp and/or the LM root. Ramp lesions were more frequent in males (23% vs 12% in females, p < 0.01), in contact injuries (28% vs 16% in non-contact, p < 0.05) and in complete ACL tears (21% vs 5% in partial, p < 0.05). Combined injuries of the MM ramp and the LM root showed a higher percentage of contact injuries compared to non-contact injuries (10% vs 4%, p < 0.05). CONCLUSION Two-thirds of all ACL injuries showed a concomitant meniscus injury, of which half involved the biomechanically relevant, but previously often undiagnosed RLMM or the PRLM. These findings provide evidence that until recently about half of ACL-associated meniscus injuries were not properly identified. Ramp lesions were more frequent in males, contact injuries and in complete ACL tears. These findings stress the need for a systematic assessment and a better understanding of the pathomechanism of these specific injuries which may have an important impact on knee biomechanics and the outcome of ACL reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Amanda Magosch
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg
| | - Caroline Mouton
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Christian Nührenbörger
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Romain Seil
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78, rue d' Eich, 1460, Luxembourg, Luxembourg.
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg.
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg.
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Lateral Meniscus Posterior Root Injury: MRI Findings in Children With Anterior Cruciate Ligament Tear. AJR Am J Roentgenol 2021; 217:984-994. [PMID: 33728972 DOI: 10.2214/ajr.21.25554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. Undiagnosed and unrepaired root tears are increasingly recognized as a preventable cause of accelerated osteoarthritis. Preoperative MRI findings of lateral meniscus posterior root tears in children with concomitant anterior cruciate ligament (ACL) injury are not well described. OBJECTIVE. The purpose of this study was to investigate the performance of preoperative MRI for identifying concomitant lateral meniscus posterior root injuries in pediatric patients with ACL tears with arthroscopy as the reference standard. METHODS. Consecutively registered children who underwent MRI within 90 days before arthroscopic primary ACL reconstruction between March 2017 and December 2019 were included. Two radiologists assessed MRI examinations for direct signs involving the root proper and for findings associated with lateral meniscus posterior root tears. Kappa coefficients for MRI findings were computed. Findings in patients with root tears and intact roots were compared by independent-samples t test, Mann-Whitney U test, chi-square test, Fisher exact test, and multivariable logistic regression analysis. RESULTS. At arthroscopy, 39 children (18 boys, 21 girls; mean age, 15.2 ± 1.4 years) had lateral meniscus posterior root tears; 51 (22 boys, 29 girls; mean age, 15.7 ± 1.8 years) had intact roots. Kappa coefficients ranged from 0.65 to 0.92, aside from tears involving the entheseal segment (κ = 0.55) or popliteomeniscal fascicles (κ = 0.45). MRI findings that were predictors of arthroscopically diagnosed root tear (p < .05) were lateral meniscus root tear in any segment (odds ratio [OR], 16.8; 95% CI, 5.6-50.1), degeneration in any segment (OR, 3.9; 95% CI, 1.6-9.6), coronal cleft sign (OR, 5.7; 95% CI, 2.0-16.7), sagittal ghost sign (OR, 4.8; 95% CI, 1.2-19.1), and axial radial defect sign (OR, 7.1; 95% CI, 2.4-20.5). Tear involving any segment of the root proper had the highest PPV, 82%, with 79% NPV. The coronal cleft, sagittal ghost, and axial radial defect signs had specificities of 88%, 94%, and 88% but sensitivities of 44%, 23%, and 49%. The only significant independent predictor on preoperative MRI was root tear in any segment (OR, 15.8; 95% CI, 2.7-137.5; p = .003). CONCLUSION. Among MRI findings evaluated for preoperative diagnosis of lateral meniscus posterior root tear, tear involving any segment of the root proper had the strongest performance; associated findings had high specificity but low sensitivity. CLINICAL IMPACT. Accurate identification of lateral meniscus posterior root tears on preoperative MRI can aid in operative planning and reduce treatment delay.
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H-Plasty Repair Technique Improved Tibiofemoral Contact Mechanics After Repair for Adjacent Radial Tears of Posterior Lateral Meniscus Root: A Biomechanical Study. Arthroscopy 2021; 37:2204-2216.e2. [PMID: 33621646 DOI: 10.1016/j.arthro.2021.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 01/31/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the time-zero tibiofemoral contact mechanics among the 4 different suturing repairs: transtibial pullout suture repair, suture anchor repair, side-to-side repair, and H-plasty repair. METHODS Twenty-four human cadaveric knees were included. Each lateral meniscus condition (intact, radial tear, and repair) was tested under a 1000-N axial compressive load at 0°, 30°, 60°, and 90° of flexion. Four different repair techniques, transtibial pullout, suture anchor, side-to-side, and H-plasty repair technique, were tested. Tibiofemoral mean and peak contact pressure and contact area in the lateral and medial compartments were measured by Tekscan sensors. RESULTS Radial tears adjacent to the posterior lateral meniscus root produced significantly decreased contact area and increased mean and peak contact pressures in the lateral compartment across all angles (P < .05). All repair groups could improve the contact mechanics relative to the torn condition (P < .05), but only H-plasty repair showed no significant difference in the mean and peak contact pressure and contact area compared with that of the intact state at all flexion angles (P > .05). CONCLUSIONS The results showed that the tibiofemoral contact mechanics after adjacent radial tears of the posterior lateral meniscal root were improved to the intact level by H-plasty repair at time-zero. The additional vertical mattress sutures act as "stabilizers" to provide a more stable environment in distributing vertical tibiofemoral pressure. The other 3 repair techniques also significantly improved lateral tibiofemoral contact mechanics relative to the corresponding tear conditions. CLINICAL RELEVANCE The results of this study suggest that H-plasty repair can restore the biomechanical properties to the intact state. Since it was a time-zero cadaveric study, the results should be carefully used in clinical practices.
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Petersen W. Editorial Commentary: Medial and Lateral Meniscus Root Injuries Are Distinct, and Indications for Repair May Differ: Get Down to the Root of the Problem! Arthroscopy 2021; 37:2217-2219. [PMID: 34226010 DOI: 10.1016/j.arthro.2021.03.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 02/02/2023]
Abstract
Medial and lateral root injuries are different clinical entities. Medial root injuries are of a degenerative nature and frequently are associated with obesity and varus deformity. Lateral root injuries, however, are more often of traumatic origin and usually associated with injuries to the anterior cruciate ligament. There is also a biomechanical difference between the 2 injuries. In the case of medial root injuries, the loss of circular hoop tension leads to an increase in peak contact pressure. In the case of lateral root lesions, the loss of hoop stress can be compensated for by an intact meniscofemoral ligament. Nevertheless, a repair also seems to make sense on the lateral meniscus, as the posterior root also has a stabilizing effect on the knee. The most suitable technique for lateral root repair depends on the type of lesion. A transtibial pull out repair is suitable for frequent avulsion injuries (type 1). In the case of type 2 injuries, which are also common, a side-to-side suture is an option.
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Willinger L, Athwal KK, Williams A, Amis AA. An Anterior Cruciate Ligament In Vitro Rupture Model Based on Clinical Imaging. Am J Sports Med 2021; 49:2387-2395. [PMID: 34115540 PMCID: PMC8283191 DOI: 10.1177/03635465211017145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biomechanical studies on anterior cruciate ligament (ACL) injuries and reconstructions are based on ACL transection instead of realistic injury trauma. PURPOSE To replicate an ACL injury in vitro and compare the laxity that occurs with that after an isolated ACL transection injury before and after ACL reconstruction. STUDY DESIGN Controlled laboratory study. METHODS Nine paired knees were ACL injured or ACL transected. For ACL injury, knees were mounted in a rig that imposed tibial anterior translation at 1000 mm/min to rupture the ACL at 22.5° of flexion, 5° of internal rotation, and 710 N of joint compressive force, replicating data published on clinical bone bruise locations. In contralateral knees, the ACL was transected arthroscopically at midsubstance. Both groups had ACL reconstruction with bone-patellar tendon-bone graft. Native, ACL-deficient, and reconstructed knee laxities were measured in a kinematics rig from 0° to 100° of flexion with optical tracking: anterior tibial translation (ATT), internal rotation (IR), anterolateral (ATT + IR), and pivot shift (IR + valgus). RESULTS The ACL ruptured at 26 ± 5 mm of ATT and 1550 ± 620 N of force (mean ± SD) with an audible spring-back tibiofemoral impact with 5o of valgus. ACL injury and transection increased ATT (P < .001). ACL injury caused greater ATT than ACL transection by 1.4 mm (range, 0.4-2.2 mm; P = .033). IR increased significantly in ACL-injured knees between 0° and 30° of flexion and in ACL transection knees from 0° to 20° of flexion. ATT during the ATT + IR maneuver was increased by ACL injury between 0° and 80° and after ACL transection between 0° and 60°. Residual laxity persisted after ACL reconstruction from 0° to 40° after ACL injury and from 0° to 20° in the ACL transection knees. ACL deficiency increased ATT and IR in the pivot-shift test (P < .001). The ATT in the pivot-shift increased significantly at 0° to 20° after ACL transection and 0° to 50° after ACL injury, and this persisted across 0° to 20° and 0° to 40° after ACL reconstruction. CONCLUSION This study developed an ACL injury model in vitro that replicated clinical ACL injury as evidenced by bone bruise patterns. ACL injury caused larger increases of laxity than ACL transection, likely because of damage to adjacent tissues; these differences often persisted after ACL reconstruction. CLINICAL RELEVANCE This in vitro model created more realistic ACL injuries than surgical transection, facilitating future evaluation of ACL reconstruction techniques.
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Affiliation(s)
- Lukas Willinger
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK,Orthopaedic Surgery Department, Technical University of Munich, Munich, Germany
| | - Kiron K. Athwal
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK
| | - Andy Williams
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK,Fortius Clinic, London, UK
| | - Andrew A. Amis
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK,Andrew A. Amis, FREng, DSc(Eng), Mechanical Engineering Department, Imperial College London, London, SW7 2AZ, UK ()
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Polat A, Acar N, Aybar A, Fidan F, Özden E, Gürkan O. The correlation between posterior cruciate ligament buckling sign and meniscofemoral ligaments: A radiological study. Jt Dis Relat Surg 2021; 32:371-376. [PMID: 34145813 PMCID: PMC8343856 DOI: 10.52312/jdrs.2021.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/21/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives
This study aims to investigate the correlation between posterior cruciate ligament (PCL) buckling phenomena and the presence or absence of the anterior meniscofemoral ligament (aMFL). Patients and methods
Between January 2012 and January 2019, magnetic resonance imaging of a total of knee joints of 199 patients (163 males, 16 females; mean age: 31.5±5.3 years; range, 18 to 40 years) were reviewed retrospectively. The patients were divided into four groups. The first group included 32 patients with a ruptured anterior cruciate ligament (ACL) and absent aMFL. The second group included 67 patients with a ruptured ACL and apparent aMFL. The third group included 23 patients with an intact ACL and absent aMFL, and the fourth group included 77 patients with an intact ACL and apparent aMFL. The PCL angle was used to measure the buckling degree of the ligament, as calculated as the angle between two lines drawn through the tibial and femoral central portions of the PCL insertions. We assessed the buckling phenomena of the PCL in ACL-ruptured and ACL-intact knees and examined a possible correlation between the PCL buckling angle and the presence or absence of the aMFL of Humphrey. Results
In the ruptured ACL groups (Groups 1 and 2), the mean PCL buckling angle values were 133.88±6.32 and 104.83±7.34 degrees, respectively. A significant difference was detected between both groups (p=0.026). In the intact ACL groups (Groups 3 and 4), the mean PCL buckling angle values were 143.47±5.96 and 116.77±8.38 degrees, respectively. A significant difference was detected between both groups (p=0.039). No statistically significant difference was observed between Groups 1 and 3 (p=0.13) and between Groups 2 and 4 (p=0.088). Conclusion
The PCL buckling sign is not specific for ACL ruptures, and can be seen frequently in normal knee joints which it is strongly associated with the presence of aMFL of Humphrey.
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Affiliation(s)
- Abdulkadir Polat
- Gaziosmanpaşa Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji Kliniği, 34255 Gaziosmanpaşa, İstanbul, Türkiye.
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Wagala NN, Tisherman RT, Lucidi GA, Eads R, Musahl V. Meniscal problems in the ACL deficient knee: What every ACL surgeon must be able to do! OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Update Wurzel- und Rampenläsionen. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00457-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zheng T, Song G, Li Y, Zhang Z, Ni Q, Cao Y, Feng Z, Zhang H, Feng H. Clinical, Radiographic, and Arthroscopic Outcomes of Surgical Repair for Radial and Avulsed Lesions on the Lateral Meniscus Posterior Root During ACL Reconstruction: A Systematic Review. Orthop J Sports Med 2021; 9:2325967121989678. [PMID: 33796590 PMCID: PMC7975585 DOI: 10.1177/2325967121989678] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/28/2020] [Indexed: 01/12/2023] Open
Abstract
Background Clinical outcomes of surgical repairs for tears of the lateral meniscus posterior root (LMPR) in patients undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) have not been comprehensively investigated. Purpose To systematically review the clinical, radiographic, and arthroscopic results of surgical repairs for tears of the LMPR in patients undergoing ACLR. Study Design Systematic review; Level of evidence, 4. Methods A systematic electronic search of the PubMed and Embase databases was performed to identify studies reporting clinical, radiographic, or arthroscopic results of surgical repairs for tears of the LMPR in patients undergoing ACLR. Each included study was abstracted regarding study characteristics, patient characteristics, surgical technique, and outcome measures. The methodological quality of the included studies was analyzed according to the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results Nine studies were included in this systematic review, representing a total of 215 knees in 215 patients. Overall, 123 side-to-side repairs and 89 pullout repairs were performed for tears of the LMPR during ACLR. After a mean follow-up of 33.9 months, significant improvements (P < .05) were found in the mean Lysholm score (from 58.3 to 91.4) as well as the mean International Knee Documentation Committee subjective score (from 61.1 to 87.2). Weightbearing anteroposterior radiographs of 41 patients showed no significant narrowing of lateral joint space width. On magnetic resonance imaging scans, 31 patients demonstrated no significant progression of chondral lesions, and no significant decreases in meniscal extrusion on coronal planes were reported in another 76 patients. The complete/partial healing was 93.6% on second-look arthroscopy after side-to-side repairs for radial tears of the LMPR. The MINORS value showed a high risk of bias for all 9 studies. Conclusion Patients with tears of the LMPR associated with ACL injuries achieved favorable functional scores after ACLR and LMPR repairs, and the side-to-side repair for radial tears of the LMPR succeeded in a high meniscal healing rate of >90%. However, the authors of this review were unable to definitively conclude whether LMPR repairs fully restore the hoop stress of the lateral meniscus.
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Affiliation(s)
- Tong Zheng
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Guanyang Song
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Yue Li
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Zhijun Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Qiankun Ni
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Yanwei Cao
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Zheng Feng
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Hui Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Hua Feng
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
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Knapik DM, Salata MJ, Voos JE, Greis PE, Karns MR. Role of the Meniscofemoral Ligaments in the Stability of the Posterior Lateral Meniscus Root After Injury in the ACL-Deficient Knee. JBJS Rev 2021; 8:e0071. [PMID: 32105238 DOI: 10.2106/jbjs.rvw.19.00071] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
» Injuries to the posterior root of the lateral meniscus occur frequently in acute knee injuries with concomitant tearing of the anterior cruciate ligament (ACL).
» The meniscofemoral ligaments (MFLs), consisting of the anterior MFL (ligament of Humphrey) and the posterior MFL (ligament of Wrisberg), as well as the osseous attachment of the meniscal root, stabilize the lateral meniscus, enabling appropriate load transmission and maintenance of contact forces within the lateral compartment of the knee during loading and range of motion.
» In the setting of an ACL injury to the knee with osseous root injury of the posterior root of the lateral meniscus, the MFLs (when present) may stabilize the lateral meniscus against meniscal extrusion, thereby maintaining appropriate contact mechanics within the knee, decreasing the risk of subsequent chondral and meniscal injury and the development of premature osteoarthritis.
» Additional study on the indications for posterior meniscal root repair during ACL reconstruction is warranted since the ideal management of lateral root injury in the MFL-intact knee remains unknown.
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Affiliation(s)
- Derrick M Knapik
- University Hospitals Sports Medicine Institute, Cleveland, Ohio.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Michael J Salata
- University Hospitals Sports Medicine Institute, Cleveland, Ohio.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - James E Voos
- University Hospitals Sports Medicine Institute, Cleveland, Ohio.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Patrick E Greis
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Michael R Karns
- University Hospitals Sports Medicine Institute, Cleveland, Ohio.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
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Jacquet C, Magosch A, Mouton C, Seil R. The aspiration test: an arthroscopic sign of lateral meniscus posterior horn instability. J Exp Orthop 2021; 8:17. [PMID: 33646453 PMCID: PMC7921266 DOI: 10.1186/s40634-021-00327-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/14/2021] [Indexed: 01/12/2023] Open
Abstract
The suspensory mechanism of the posterior horn of the lateral meniscus (PHLM) is an anatomically complex structure including the popliteomeniscal fascicles, the meniscotibial posterior root attachment and the meniscofemoral ligaments. Damage to one or several of these structures – either through knee trauma or congenital abnormalities—can result in an instability of the PHLM that may lead to lateral knee pain, locking sensations or lack of rotational control of the knee (e.g. after anterior cruciate ligament injuries). The diagnosis of PHLM instability is complex due to the lack of reliable clinical tests and imaging signs. Direct visual dynamic inspection via arthroscopy thus remains the gold standard. However, arthroscopic probing of the PHLM is not always reliable and the precise quantification of the amount of subluxation of the PHLM can be difficult. Therefore, the main objective of this report was to describe a quick and easy arthroscopic screening test called “the aspiration test” in order to help surgeons to detect PHLM instability. During the exploration of the lateral tibiofemoral compartment with the knee kept in the figure of 4 position, the arthroscope is placed in the antero-lateral portal and directed towards the lateral tibiofemoral compartment. The aspiration test is then performed by activating the aspiration of the 4-mm shaver when located in the intercondylar notch. In case of a PHLM instability, an excessive displacement of the PHLM is observed. After repair, a second aspiration test allows to verify that the PHLM has been stabilized.
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Affiliation(s)
- Christophe Jacquet
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique D'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg.,Institute for Movement and Locomotion (IML), Department of Orthopedic Surgery and Traumatology St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Amanda Magosch
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique D'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique D'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg.,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique D'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg. .,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg. .,Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg, Luxembourg.
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Pękala PA, Łazarz DP, Rosa MA, Pękala JR, Baginski A, Gobbi A, Wojciechowski W, Tomaszewski KA, LaPrade RF. Clinical Anatomy of the Posterior Meniscofemoral Ligament of Wrisberg: An Original MRI Study, Meta-analysis, and Systematic Review. Orthop J Sports Med 2021; 9:2325967120973195. [PMID: 33748297 PMCID: PMC7903841 DOI: 10.1177/2325967120973195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/09/2020] [Indexed: 01/14/2023] Open
Abstract
Background The posterior meniscofemoral ligament (pMFL) of Wrisberg attaches to the posterior horn of the lateral meniscus and the lateral intercondylar aspect of the medial femoral condyle and passes posteriorly to the posterior cruciate ligament (PCL). The pMFL plays a role in recovery after PCL injuries and offers stability to the lateral meniscus, promoting normal knee function. Purpose/Hypothesis The aim of the magnetic resonance imaging (MRI) arm of this study was to evaluate the prevalence of the pMFL in Polish patients. The purpose of the systematic review and meta-analysis was to evaluate the clinical relevance of the pMFL in knee surgery. It was hypothesized that extensive variability exists in reports on the prevalence, function, and clinical significance of the pMFL. Study Design Cross-sectional study and systematic review; Level of evidence, 3. Methods A retrospective MRI investigation was conducted on 100 randomly selected lower limbs of Polish patients (56 male, 44 female) performed in 2019 to determine the prevalence of the pMFL. Additionally, an extensive literature search of major online databases was performed to evaluate all reported data on the pMFL. Assessments of article eligibility and data extraction were completed independently by 2 reviewers, and all disagreements were resolved via a consensus. A quality assessment of the included articles was performed using the Anatomical Quality Assessment tool. Results In the MRI arm of this study, the pMFL was observed in 73 of the 100 limbs. In the meta-analysis, 47 studies were included, totaling 4940 lower limbs. The pooled prevalence of the pMFL was found to be 70.4% (95% CI, 63.4%-76.9%); the mean length was 27.7 mm (95% CI, 24.8-30.5 mm) and the mean widths were 4.5, 6.1, and 4.1 mm for the meniscal and femoral attachments and midportion, respectively. The mean pMFL thickness was 2.3 mm (95% CI, 1.8-2.7 mm). Conclusion Despite the variability in the literature, the pMFL was found to be a prevalent and large anatomic structure in the knee joint. The shared features of this ligament with the PCL necessitate the consideration of its value in planning and performing arthroscopic procedures of the knee.
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Affiliation(s)
- Przemysław A Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Dominik P Łazarz
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz A Rosa
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub R Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Baginski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Alberto Gobbi
- Orthopaedic Arthroscopic Surgery International Bioresearch Foundation, Milan, Italy
| | - Wadim Wojciechowski
- Department of Radiology, Comarch Healthcare, Kraków, Poland.,Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof A Tomaszewski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
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Uffmann W, ElAttrache N, Nelson T, Eberlein SA, Wang J, Howard DR, Metzger MF. Posterior Lateral Meniscal Root Tears Increase Strain on the Reconstructed Anterior Cruciate Ligament: A Cadaveric Study. Arthrosc Sports Med Rehabil 2021; 3:e505-e513. [PMID: 34027462 PMCID: PMC8129456 DOI: 10.1016/j.asmr.2020.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 11/25/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To quantify the amount of strain across an anterior cruciate ligament reconstruction (ACLR) before and after a lateral meniscus (LM) posterior root complex tear and determine whether a meniscal root repair effectively protects the ACLR against excessive strain. Methods Fresh-frozen cadaveric knees were tested with an 88-N anterior drawer force and an internal and external torque of 5-Nm applied at 0°, 15°, 30°, 60°, and 90° of flexion. A simulated pivot shift was also applied at 0, 15, and 30° of flexion. Rotation and translation of the tibia, and strain across the ACL graft were recorded. Testing was repeated for the following four conditions: ACL-intact, ACLR with intact LM, ACLR with LM posterior root complex tear, and ACLR with root repair. Results The kinematic data from 12 fresh frozen cadaveric knees underwent analysis. Only 11 specimens had usable strain data. Sectioning the meniscofemoral ligaments and the LM posterior root increased rotational and translational laxity at 30° of knee flexion. ACLR graft strain significantly increased when an anterior load and internal torque were applied. Repair of the LM posterior root reduced strain when the knee was internally rotated but was unable to normalize strain when an anterior force was applied. Conclusions This cadaveric biomechanical study suggests injury to the LM posterior root complex increases rotational and anterior laxity of the knee and places increased strain across reconstructed ACL grafts. Subsequent root repair did not result in a statistically significant reduction in strain. Clinical Relevance This study provides quantitative data on the implications of a LM posterior root injury in the setting of an ACL reconstruction to help guide clinical decision-making.
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Affiliation(s)
- William Uffmann
- Cedars-Sinai Kerlan-Jobe Institute, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Neal ElAttrache
- Cedars-Sinai Kerlan-Jobe Institute, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Trevor Nelson
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Sam A Eberlein
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Juntian Wang
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Daniel R Howard
- Somers Orthopaedic Surgery & Sports Medicine, Carmel, New York, U.S.A
| | - Melodie F Metzger
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A.,Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
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Higher Incidence of Complete Lateral Meniscal Root Tears in Revision Compared With Primary Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2021; 3:e367-e372. [PMID: 34027444 PMCID: PMC8129033 DOI: 10.1016/j.asmr.2020.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 09/25/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the incidence of complete lateral meniscal posterior root tears (LMPRTs) repaired at revision as compared with primary anterior cruciate ligament (ACL) reconstruction (PACLR) and to determine whether other demographic or surgical characteristics were associated with LMPRTs needing repair. Methods A chart review was performed to identify the PACLR and revision ACL reconstruction (RACLR) cohorts. Demographic and surgical characteristics were recorded. Cases with concurrent lateral meniscal posterior root repair were identified. Cases were classified as acute (<5 months) or chronic (>5 months) based on the time from reported injury to surgery. Tunnel malposition in revision cases was recorded if either tunnel or both tunnels were malpositioned on radiographs and magnetic resonance imaging. Results Data from 167 cases, 140 PACLR and 27 RACLR cases, were included. The cohorts had similar demographic characteristics including age, sex, and lateral meniscal injury. The overall incidence of lateral meniscal root repair in ACL reconstruction patients was 12.6% (21 of 167 patients). The incidence of LMPRT repair was 7.1% (10 of 140 patients) in the PACLR cohort versus 40.7% (11 of 27 patients) in the RACLR cohort. The revision cohort was significantly more likely to have a chronic injury (66.7% [18 of 27 patients] vs 31.4% [44 of 140 patients]). The most significant predictor of concurrent lateral meniscal posterior root repair was RACLR versus PACLR for both univariate and multivariate logistic regression analyses (χ2 = 20.603; P < .0001; odds ratio, 13.887; 95% confidence interval, 1.531-125.993). Analysis of tunnel positions for the revision group revealed that PACLR tunnel malposition was a significant predictor of LMPRTs (χ2 = 4.91, P = .027). Conclusions Complete LMPRTs warranting repair are encountered with a significantly greater frequency at RACLR as compared with PACLR. The overall incidence of LMPRT repair at RACLR is high. In this cohort, LMPRT repair in RACLR cases was associated with tunnel malposition of the PACLR. Level of Evidence Level III, retrospective cohort study.
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Tang X, Marshall B, Wang JH, Zhu J, Li J, Linde MA, Smolinski P, Fu FH. Partial meniscectomy does not affect the biomechanics of anterior cruciate ligament reconstructed knee with a lateral posterior meniscal root tear. Knee Surg Sports Traumatol Arthrosc 2020; 28:3481-3487. [PMID: 32889558 DOI: 10.1007/s00167-020-06209-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/03/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study was to determine the effects of a lateral meniscus posterior root tear, partial meniscectomy, and total meniscectomy on knee biomechanics in the setting of anterior cruciate ligament (ACL) reconstruction. METHODS Thirteen fresh-frozen cadaver knees were tested with a robotic testing system under an 89.0-N anterior tibial load at full extension (FE), 15°, 30°, 60° and 90° of knee flexion and a simulated pivot-shift loading (7.0 Nm valgus and 5.0 Nm internal tibial rotation) at FE, 15° and 30° of knee flexion. Anterior tibial translation (ATT) and the in-situ force of ACL graft under the different loadings were measured in four knee states: (1) ACL reconstruction with intact lateral meniscus (Intact meniscus), (2) ACL reconstruction with lateral meniscal posterior root tear (Root tear), (3) ACL reconstruction with lateral posterior partial meniscectomy (Partial meniscectomy) and (4) ACL reconstruction with total lateral meniscectomy (Total meniscectomy). RESULTS Under anterior tibial loading, compared with an intact meniscus, root tear significantly increased ATT at 15° and 30° of knee flexion (p < 0.05) and partial meniscectomy had almost same increased ATT as with root tear at any knee flexion between FE and 90°. Under simulated pivot-shift loading, total meniscectomy increased ATT compared with intact meniscus, root tear, partial meniscectomy at FE (p < 0.05). CONCLUSION Under anterior tibial and simulated pivot-shift loading, partial meniscectomy has no significant effect on the stability of ACL-reconstructed knee with lateral meniscal posterior root tear, while total meniscectomy increased laxity at less than 30° of knee flexion. Clinically, in cases of irreparable meniscal root tears or persistent pain a partial meniscectomy can be considered in the setting of ACL reconstruction.
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Affiliation(s)
- Xin Tang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Brandon Marshall
- Department of Mechanical Engineering and Material Science Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Junjun Zhu
- Department of Mechanical Engineering and Material Science Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jian Li
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Monica A Linde
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Patrick Smolinski
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
- Department of Mechanical Engineering and Material Science Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA.
- Department of Mechanical Engineering and Material Science Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
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