Complete posterolateral meniscal root tear is associated with high-grade pivot-shift phenomenon in noncontact anterior cruciate ligament injuries

Song, Gonghua; Zhang, Hui; Liu, Xin; Zhang, Jin; Xue, Zhe; Qian, Yi; Feng, Hao

doi:10.1007/s00167-017-4495-9

Cited by 34 publications

(33 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Clinically, the patterns of LMPR lesion are not so simple and present varying forms, from partial radial tears to complete root avulsions. 13,21 Song et al 35 compared the proportions of complete LMPR lesions in ACL-injured knees with different grades of pivot shift and demonstrated that a complete LMPR lesion was an independent risk factor of high-grade pivot shift, indicating the potential influence of different LMPR lesion patterns on dynamic knee instability. In cadaveric studies testing the kinematics of ACL-deficient knees, complete detachment of the LMPR root increased anterior tibial displacement of ACL-deficient knees during anterior loading and simulated pivot-shift loading.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, the present study adds further elements to the original understanding of LMPR lesions and ATSLC in extension. 4,26,27,35,37 In ACL-deficient knees, the loss of the “wedge effect” maintained by the posterior horn of the lateral meniscus attributed to LMPR lesions decreases dynamic rotational stability, leaving those knees in a “resting pivoted position” under an unloaded state; thus, excessive anterior tibial subluxation was identified in the lateral tibiofemoral compartment. As greater ATSLC in extension may result in intercondylar notch impingement and chronic degeneration of the ACL graft because of the anterior shift of tibial tunnel 4,39 and as excessive ATSLC in extension could be a mechanistic rationale for the failed ACLR, 17,26,37 it is important to diagnose and surgically treat the LMPR lesion, especially the chronic root avulsion, to reestablish a normal tibiofemoral relationship in extension during ACLR for patients with high-grade ATSLC.…”

Section: Discussionmentioning

confidence: 99%

“…This study reported the period from injury as ≥12 weeks (chronic deficiency) or <12 weeks (acute injury), based on a previous study demonstrating that LMPR lesion was significantly associated with the high-grade pivot-shift phenomenon in ACL-injured knees with ≥12 weeks’ time from injury to surgery. 35…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Lateral Meniscus Posterior Root Lesion Influences Anterior Tibial Subluxation of the Lateral Compartment in Extension After Anterior Cruciate Ligament Injury

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: The lateral meniscus posterior root (LMPR) lesion further decreases dynamic knee stability after anterior cruciate ligament (ACL) injury owing to the loss of the “wedge effect” maintained by the posterior horn of the lateral meniscus. However, the effect of LMPR lesions on the static tibiofemoral relationship in extension after ACL injuries is not determined. Purpose: To (1) determine the effect of LMPR lesions on anterior tibial subluxation of the lateral compartment (ATSLC) in extension in patients with ACL injuries and to (2) identify the LMPR-related factors associated with excessive ATSLC in extension. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2015 and December 2017, 405 consecutive patients with diagnosed ACL injuries who underwent primary ACL reconstructions were retrospectively reviewed. Among them, 45 patients with combined ACL injuries and LMPR lesions (ACL+LMPR group) and 51 patients with isolated ACL injuries (ACL group) were identified. Values of ATSLC in extension were measured on preoperative supine magnetic resonance imaging and classified into high grade (≥6 mm) and low grade (<6 mm). The mean ATSLC in extension and the proportion of patients with high-grade ATSLC in extension were compared between the groups by univariate analysis. In the ACL+LMPR group, predictors of high-grade ATSLC in extension—including age, sex, body mass index, affected side, cause of injury, period from injury (<12 or ≥12 weeks), LMPR lesion pattern (radial tear or root avulsion), and meniscofemoral ligament integrity (intact or impaired)—were assessed by univariate analysis and multivariate logistic regression analysis. Results: The mean ATSLC in extension in the ACL+LMPR group was significantly greater than that in the ACL group (5.6 mm vs 3.1 mm; P = .001). The proportion of patients with high-grade ATSLC in extension in the ACL+LMPR group was also significantly larger than that in the ACL group (44.4% vs 15.7%; P = .002). In addition, the root avulsion (instead of radial tear) (odds ratio, 28.750; 95% CI, 2.344-352.549; P = .009) and the period from injury ≥12 weeks (odds ratio, 17.095; 95% CI, 1.207-242.101; P = .036) were determined to be the 2 independent predictors of high-grade ATSLC in extension. However, age, sex, body mass index, affected side, cause of injury, and meniscofemoral ligament integrity were not. Conclusion: After ACL injuries, concomitant LMPR lesion further increased ATSLC in extension. Chronic LMPR avulsion was associated with high-grade ATSLC in extension.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Lateral Meniscus Posterior Root Lesion Influences Anterior Tibial Subluxation of the Lateral Compartment in Extension After Anterior Cruciate Ligament Injury

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Monaco et al [27] demonstrated that a grade III pivot shift is only seen in the absence of both the ACL and ALL in vitro. However, the potential confusing factors of a high-grade pivot shift, such as a lateral meniscus or root tear, ITB injury, or general hyperlaxity should be assessed [28,29].…”

Section: Diagnosismentioning

confidence: 99%

Decision-Making for ALL Reconstruction and Surgical Techniques

Gürpınar¹

2020

Knee Surgery - Reconstruction and Replacement

View full text Add to dashboard Cite

The anterolateral ligament (ALL), which was first described in 1879, was reintroduced in 2013 by Claes et al. It originates near the lateral epicondyle of the distal femur, runs along the lateral outer aspect of the knee, and inserts on the proximal tibia between Gerdy's tubercle and fibular head. The ALL tightens when the knee is internally rotated (twisted inwards), and in doing so, it is proposed to be a stabilizer to internal tibial rotation. Biomechanical studies showed that the ALL restrains internal rotation of the tibia and thus affects the pivot-shift phenomenon in the anterior cruciate ligament (ACL)-injured knee. Therefore, it is proposed that the deficient ALL can be a reason for persistent rotatory instability after ACL reconstruction. Furthermore, ALL reconstruction techniques have evolved and indications extended. Commonly accepted indications for concomitant ACL and ALL reconstruction are ACL revisions, high-grade pivot-shift test, chronic ACL rupture, and young patients and patients doing pivoting activities. Most surgeons perform an anatomic reconstruction technique with gracilis autograft. However, only few studies published reporting the outcomes of ALL reconstruction and more studies with longer follow-up times are, therefore, needed to provide the compelling clinical evidence for the efficacy of concomitant ACL and ALL procedures.

show abstract

“…In addition, LMRT were significantly associated with a high-grade pivot-shift in noncontact ACL injuries (odds ratio, 4.044; 95% confidence interval, 1.125-14.534; P= 0.032). 48 …”

Section: Beyond the Alc: Other Contributions To Instability In The Acmentioning

confidence: 99%

The Anterolateral Ligament is Not the Whole Story: Reconsidering the Form and Function of the Anterolateral Knee and its Contribution to Rotatory Knee Instability

Sheean

Shin

Patel

et al. 2018

Techniques in Orthopaedics

View full text Add to dashboard Cite

The heterogeneity of available cadaveric, histologic, and radiographic results related to the anterolateral ligament (ALL) does not support its existence as a discrete anatomic structure. Moreover, focusing narrowly on the ALL in isolation, what has previously been referred to as “ALL myopia,” obscures a thorough appreciation for the stability contributions of both capsular and extracapsular structures. We consider injury to the soft tissues of the anterolateral knee–the anterolateral complex—just one component of what is frequently found to be a spectrum of pathology observed in the rotationally unstable, anterior cruciate ligament (ACL)-deficient knee. Increased lateral tibial slope, meniscal root tears, and “ramp” lesions of the medial meniscocapsular junction have all been implicated in persistent rotatory knee instability, and the restoration of rotational stability requires a stepwise approach to the assessment of each of these entities. Through an appreciation for the multifactorial nature of rotatory knee instability, surgeons will be better equipped to perform durable ACL reconstructions that maximize the likelihood of optimal clinical outcomes for patients. The purposes of this review are to provide an update on the relevant anatomy of the anterolateral knee soft tissues and to explain the multifactorial nature of rotatory knee instability in the setting of ACL deficiency.

show abstract

Complete posterolateral meniscal root tear is associated with high-grade pivot-shift phenomenon in noncontact anterior cruciate ligament injuries

Abstract: IV.

Cited by 34 publications

References 31 publications

Lateral Meniscus Posterior Root Lesion Influences Anterior Tibial Subluxation of the Lateral Compartment in Extension After Anterior Cruciate Ligament Injury

Lateral Meniscus Posterior Root Lesion Influences Anterior Tibial Subluxation of the Lateral Compartment in Extension After Anterior Cruciate Ligament Injury

Decision-Making for ALL Reconstruction and Surgical Techniques

The Anterolateral Ligament is Not the Whole Story: Reconsidering the Form and Function of the Anterolateral Knee and its Contribution to Rotatory Knee Instability

Contact Info

Product

Resources

About