Consequences of Tibial Tunnel Reaming on the Meniscal Roots During Cruciate Ligament Reconstruction in a Cadaveric Model, Part 1

LaPrade, Christopher M.; Smith, Sean D.; Rasmussen, Matthew T.; Hamming, Mark G.; Wijdicks, Coen A.; Engebretsen, Lars; Feagin, John A.; LaPrade, Robert F.

doi:10.1177/0363546514554769

Cited by 59 publications

(46 citation statements)

References 34 publications

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“…These fibers specifically act on the LM anterior root attachment itself, explaining the reduction in the ultimate failure strength of the LM anterior root with disruption of these fibers. 7,19 Ellman et al 20 reported that the fibers overlying the ACL tibial insertion did not significantly modify the strength or the stiffness of the LM anterior root. Therefore, the LM extrusion identified in our study could have possibly resulted from damage to the fibers of the LM inserting into the subchondral bone.…”

Section: Discussionmentioning

confidence: 99%

“…18,28,33,34 Ziegler et al and Zantop et al reported this "true" center to be located 7.5 mm from the center of the LM anterior root. 2,18 However, LaPrade et al 7 suggested that the functional importance of the supplemental soft tissue fibers of the LM anterior root should be considered and suggested a location at 5.0 mm from the center of the LM anterior root. We agree with this latter recommendation.…”

Section: Location Of the Tibial Tunnelmentioning

confidence: 99%

“…This anatomical coupling between the ACL and the LM is likely to contribute to the extent of LM extrusion after tears of the anterior horn of the meniscus, explaining the significantly higher incidence of cartilage degeneration associated with anterior horn tears. 7 A previous histological study of the tibial attachment of the ACL demonstrated that the LM anterior root form an ACL-LM complex via dense fiber connections located on the tibial surface. 8 Using safranin O staining, Furumatsu et al 8 demonstrated that fibers of the ACL-LM complex become gradually more dense from their posterior to anterior points of attachment, with the ACL-LM transition zone being located 7-8 mm from the anterior ridge of the tibia.…”

mentioning

confidence: 98%

“…8 Using safranin O staining, Furumatsu et al 8 demonstrated that fibers of the ACL-LM complex become gradually more dense from their posterior to anterior points of attachment, with the ACL-LM transition zone being located 7-8 mm from the anterior ridge of the tibia. Additionally, in their study of 12 cadaveric knees, LaPrade et al 7 reported a significant reduction in the ultimate failure strength of the attachment of the LM anterior root after reaming of the tibial tunnel during anatomic single-bundle (SB) ACL reconstruction.…”

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confidence: 99%

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Location of the tibial tunnel aperture affects extrusion of the lateral meniscus following reconstruction of the anterior cruciate ligament

et al. 2017

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The anterior root of the lateral meniscus provides functional stability to the meniscus. In this study, we evaluated the relationship between the position of the tibial tunnel and extrusion of the lateral meniscus after anterior cruciate ligament reconstruction, where extrusion provides a proxy measure of injury to the anterior root. The relationship between extrusion and tibial tunnel location was retrospectively evaluated from computed tomography and magnetic resonance images of 26 reconstructed knees, contributed by 25 patients aged 17-31 years. A measurement grid was used to localize the position of the tibial tunnel based on anatomical landmarks identified from the three-dimensional reconstruction of axial computed tomography images of the tibial plateaus. The reference point-to-tibial tunnel distance (mm) was defined as the distance from the midpoint of the lateral edge of the grid to the posterolateral aspect of the tunnel aperture. The optimal cutoff of this distance to minimize post-operative extrusion was identified using receiver operating curve analysis. Extrusion of the lateral meniscus was positively correlated to the reference point-to-tibial tunnel distance (r = 0.64; p< 0.001), with a cutoff distance of 5 mm having a sensitivity to extrusion of 83% and specificity of 93%. The mean extrusion for a distance >5 mm was 0.40 ± 0.43 mm, compared to 1.40 ± 0.51 mm for a distance ≤5 mm (p < 0.001). Therefore, a posterolateral location of the tibial tunnel aperture within the footprint of the anterior cruciate ligament decreases the reference point-to-tibial tunnel distance and increases extrusion of the lateral meniscus post-reconstruction. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1625-1633, 2017.

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Section: Discussionmentioning

confidence: 99%

Section: Location Of the Tibial Tunnelmentioning

confidence: 99%

mentioning

confidence: 98%

mentioning

confidence: 99%

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Location of the tibial tunnel aperture affects extrusion of the lateral meniscus following reconstruction of the anterior cruciate ligament

et al. 2017

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“…This anteromedial injury might obfuscate the recognition of ALMR injury. Nevertheless, a number of cadaveric studies have indicated that anatomic single-bundle ACL reconstruction can significantly decrease ALMR attachment area and strength, as the native ACL tibial insertion is overlapped with the ALMR (Laprade et al 2014b; Watson et al 2015). Regarding the attachment area, some studies report that the ALMR is smaller than the anteromedial meniscal root (44.5 mm 2 vs 93 mm 2 ) (Johnson et al 1995; Kohn & Moreno 1995).…”

Section: Discussionmentioning

confidence: 99%

Does anatomic single-bundle ACL reconstruction using hamstring autograft produce anterolateral meniscal root tearing?

et al. 2017

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BackgroundTo determine if tibial tunnel reaming during anatomic single-bundle anterior cruciate ligament (ACL) reconstruction using hamstring autograft can result in anterolateral meniscal root injury, as diagnosed by magnetic resonance imaging (MRI).MethodsA case series of 104 primary anatomic single-bundle ACL reconstructions using hamstring autograft was retrospectively reviewed. Pre- and post-operative (>1 year) MRIs were radiologically evaluated for each patient, with a lateral meniscus extrusion > 3 mm at the level of the medial collateral ligament midportion on a coronal MRI, to establish anterolateral meniscal root injury.ResultsNo patients presented radiological findings of anterolateral meniscal root injury in this case series.ConclusionsExamining a single-bundle ACL reconstruction technique using hamstring autograft that considered tibial tunnel positioning in the center of the tibial footprint, this case series found no evidence of anterolateral meniscal root injury in patient MRIs, even more than 1-year post-operation.

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ACL injury and reconstruction affect control of ground reaction forces produced during a novel task that simulates cutting movements

Lanier

Knarr

Stergiou

et al. 2020

Journal Orthopaedic Research

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After anterior cruciate ligament (ACL) injury and reconstruction, biomechanical and neuromuscular control deficits persist and 25% of those who have experienced an ACL injury will experience a second ACL rupture in the first year after returning to sports. There remains a need for improved rehabilitation and the ability to detect an individual's risk of secondary ACL rupture. Nonlinear analysis metrics, such as the largest Lyapunov exponent (LyE) can provide new biomechanical insight in this population by identifying how movement patterns evolve over time. The purpose of this study was to determine how ACL injury, ACL reconstruction (ACLR), and participation in high‐performance athletics affect control strategies, evaluated through nonlinear analysis, produced during a novel task that simulates forces generated during cutting movements. Uninjured recreational athletes, those with ACL injury who have not undergone reconstruction (ACLD [ACL deficient]), those who have undergone ACL reconstruction, and high‐performance athletes completed a task that simulates cutting forces. The LyE calculated from forces generated during this novel task was greater (ie, force control was diminished) in the involved limb of ACLD and ACLR groups when compared with healthy uninjured controls and high‐performance athletes. These data suggest that those who have experienced an ACL injury and subsequent reconstructive surgery exhibit poor force control when compared with both uninjured controls and high‐performance athletes. Clinical significance: significantly larger LyE values after ACL injury and reconstruction when compared with healthy athletes suggest a continuing deficit in force control not addressed by current rehabilitation protocols and evaluation metrics that could contribute to secondary ACL rupture.

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Consequences of Tibial Tunnel Reaming on the Meniscal Roots During Cruciate Ligament Reconstruction in a Cadaveric Model, Part 1

Cited by 59 publications

References 34 publications

Location of the tibial tunnel aperture affects extrusion of the lateral meniscus following reconstruction of the anterior cruciate ligament

Location of the tibial tunnel aperture affects extrusion of the lateral meniscus following reconstruction of the anterior cruciate ligament

Does anatomic single-bundle ACL reconstruction using hamstring autograft produce anterolateral meniscal root tearing?

ACL injury and reconstruction affect control of ground reaction forces produced during a novel task that simulates cutting movements

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