Does meniscus removal affect ACL-deficient knee laxity? An in vivo study

Zaffagnini, Stefano; Signorelli, Cecilia; Bonanzinga, Tommaso; Grassi, Alberto; Galan, Hernán; Akkawi, Ibrahim; Bragonzoni, Laura; Cataldi, Fabio; Marcacci, Maurilio

doi:10.1007/s00167-016-4222-y

Cited by 28 publications

(26 citation statements)

References 24 publications

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“…They also contribute mechanical stability of the knee along with cruciate ligaments specially rotary stability giving additional gliding function to the hinge type of knee joint [9] . Meniscectomy has bad influence on joint alignment, load distribution and anterior instablilty [3,4,5] . Medial meniscectomy increases tibio femoral contact stresses by 100% whereas lateral meniscectomy increases contact stresses by 200% to 300%.…”

Section: Resultsmentioning

confidence: 99%

“…Follow up as long as 40 years after medial meniscectomy has shown reduced femoro tibial angle leading to varus malalignment and lower flexion range of the knee [3] . Lorbach et al has shown that medial meniscectomy increases anterior tibial translation in ACL deficient knees by significant amount by Lorbach et al [4,5] Total lateral meniscectomy or its untreated root tear is also associated with increase posterolateral rotary instability postoperatively due to its anatomical proximity to popliteus tendon and posterolateral capsule [6] . Meniscus repair has higher healing potential.…”

Section: Introductionmentioning

confidence: 99%

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Influence of meniscal repair versus meniscectomy on ACL reconstruction in terms of knee stability and radiological imaging

Deore¹,

Patil²,

Kale³

et al. 2017

Int. J. Orthop. Sci.

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Objective: To compare effect of meniscus repair and meniscectomy in patients undergoing ACL reconstruction in terms of clinical instability and radiological tunnel widening 1 year after surgery. Introduction: Meniscectomy has been shown to have detrimental effects on knee in terms of increased contact pressure in femoral and tibial condyles, rotary instability and early changes of osteoarthritis. These changes are exaggerated in ACL deficient knees. Patients present to the surgeon at different times after injury ranging from 3 weeks to one year. Depending upon status of meniscal tears and its reparability at the time of surgery, surgeon has to choose between meniscectomy and meniscus repair during ACL reconstruction. We tried to compare meniscus repair and meniscectomy in terms of knee stability and radiological tunnel widening after ACL reconstruction in short term follow up. Methodology: 30 patients who underwent ACL reconstruction were selected after going through selection criteria, were divided between meniscus repair group and meniscus excision group. Meniscus tears, which were in the red red zone were repaired with inside out, all inside and outside in methods, depending upon their location from anterior to posterior zones. Those tears which presented late were irreducible, avascular and became loose body scuffing articular cartilage, were excised with shaver. All patients underwent standard ACL reconstruction with hamstring graft. Patients were evaluated clinically and radiologically at 3 months 6 months and 12 months. Results: Group 1 had 14 patients who underwent meniscus repair and group 2 had 16 patients who underwent meniscectomy during ACL reconstruction. Evaluation with Lachman's test showed that, 14% patients (2 out of 14) from Group 1 had grade 2 Lachman test. Thirty seven % of group 2 had grade 2 Lachman test though the difference was not significant (p = 0.151). Tibial tunnel diameter in meniscectomy group increased from 8 mm to 11.86mm (S.D= 1.11.) at 12 months. Tibial diameter in group 2 increased from 8 mm to 12.28 mm (S.D. = 1.52), (p= 0.394). Conclusion: Whenever ACL tear is associated with medial or lateral meniscal tears, meniscal repair is the preferred treatment over meniscectomy. The amount of tunnel widening is higher when meniscus is excised as compared to meniscal repair. The anterior tibial translation remains higher when meniscus is excised during ACL reconstruction, though short term functional results are same.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of meniscal repair versus meniscectomy on ACL reconstruction in terms of knee stability and radiological imaging

Deore¹,

Patil²,

Kale³

et al. 2017

Int. J. Orthop. Sci.

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“…Regarding the effect of medial meniscus removal on AP laxity, several cadaveric studies have reported results that are consistent with those of the present study. 15,22,36 Lorbach et al, 14 in an experimental setting of 18 human knee specimens with transected ACL, showed a significant increase of anterior tibial translation after partial medial meniscectomy with respect to the isolated ACL injury using a robotic testing system. Despite different settings and instruments, the values of 13.6 mm for isolated ACL sectioning and 15.4 mm for ACL and medial meniscectomy during the Lachman maneuver at 30° are consistent with the values of 11.1 and 15.8 mm, respectively, reported in the 2 groups of the present study.…”

Section: Discussionmentioning

confidence: 99%

“…The amount of resected meniscal tissue should not be overlooked, as subtotal meniscectomies due to bucket-handle tears have been proved to produce greater laxity compared with partial meniscectomies of the posterior horn. 36 Despite the amount of meniscectomy, Seon et al 26 concluded that the effect of medial meniscectomy “was larger at higher flexion angle than lower flexion angle” after ACL reconstruction. This insight from their cadaveric study is confirmed by the data of the present in vivo evaluation, where in fact a significantly greater laxity was found only at 90° of flexion and, conversely, a greater laxity reduction after ACL reconstruction was found at 30°.…”

Section: Discussionmentioning

confidence: 99%

“…Differences between the groups were considered statistically significant at P < .05. An a priori power analysis was performed based on the preliminary results of a similar study 36 : considering a value of AP laxity at 90° of 7 mm with intact meniscus and of 10.7 mm with partial meniscectomy and with a standard deviation of 2.5 mm, at least 13 patients in each group were required to have a power of 90% and a type 1 error of .05. P values were adjusted using the Sidak post hoc correction for multiple comparisons.…”

Section: Methodsmentioning

confidence: 99%

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The Contribution of Partial Meniscectomy to Preoperative Laxity and Laxity After Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction: In Vivo Kinematics With Navigation

et al. 2019

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Background: Limited in vivo kinematic information exists on the effect of clinical-based partial medial and lateral meniscectomy in the context of anterior cruciate ligament (ACL) reconstruction. Hypothesis: In patients with ACL deficiency, partial medial meniscus removal increases the anteroposterior (AP) laxity with compared with those with intact menisci, while partial lateral meniscus removal increases dynamic laxity. In addition, greater postoperative laxity would be identified in patients with partial medial meniscectomy. Study design: Cross-sectional study; Level of evidence, 3. Methods: A total of 164 patients with ACL tears were included in the present study and divided into 4 groups according to the meniscus treatment they underwent: patients with partial lateral meniscectomy (LM group), patients with partial medial meniscectomy (MM group), patients with partial medial and lateral meniscectomy (MLM group), and patients with intact menisci who did not undergo any meniscus treatment (IM group). A further division in 2 new homogeneous groups was made based on the surgical technique: 46 had an isolated single-bundle anatomic ACL reconstruction (ACL group), while 13 underwent a combined single-bundle anatomic ACL reconstruction and partial medial meniscectomy (MM-ACL group). Standard clinical laxities (AP translation at 30° of knee flexion, AP translation at 90° of knee flexion) and pivot-shift (PS) tests were quantified before and after surgery by means of a surgical navigation system dedicated to kinematic assessment. The PS test was quantified through 3 different parameters: the anterior displacement of the lateral tibial compartment (lateral AP); the posterior acceleration of the lateral AP during tibial reduction (posterior acceleration); and finally, the area included by the lateral AP translation with respect to the flexion/extension angle (area). Results: In the ACL-deficient status, the MM group showed a significantly greater tibial translation compared with the IM group ( P < .0001 for AP displacement at 30° [AP30] and 90° [AP90] of flexion) and the LM group ( P = .002 for AP30 and P < .0001 for AP90). In the PS test, the area of LM group was significantly larger (57%; P = .0175) than the one of the IM group. After ACL reconstruction, AP translation at 30° was restored, while the AP90 remained significantly greater at 1.3 mm ( P = .0262) in the MM-ACL group compared with those with intact menisci. Conclusion: Before ACL reconstruction, partial medial meniscectomy increased AP laxity at 30° and 90° and lateral meniscectomy increased dynamic PS laxity with respect to intact menisci. Anatomic single-bundle ACL reconstruction decreased laxities, but a residual anterior translation of 1.3 mm at 90° remained in patients with partial medial meniscectomy, with respect to those with intact menisci.

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Ramp lesions of the medial meniscus are associated with greater preoperative anterior knee laxity in anterior cruciate ligament injury

Tokura,

Nagai,

Hoshino

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo assess the incidence of ramp lesions in anterior cruciate ligament (ACL) injuries and to compare preoperative knee laxity between the patients with and without ramp lesions by using an electromagnetic measurement system (EMS).MethodsTwo hundred six patients who underwent primary ACL reconstruction with preoperative EMS measurements were retrospectively enrolled in the present study. The diagnoses of the ramp lesions were made by arthroscopic inspections. The patients with ramp lesions and no other meniscal lesions were allocated to ‘ramp group’, and the patients without any meniscal lesions were allocated to ‘control group’. Before ACL reconstruction under general anaesthesia, the side‐to‐side difference (SSD) in anterior tibial translation (ATT) during Lachman test (mm) and tibial acceleration (m/s2) of posterior tibial reduction during the pivot‐shift test was measured using the EMS. The SSD in tibial internal/external rotation angle (°) at 30, 60 and 90 were further measured using the EMS. The SSD in ATT using KT‐2000 was also measured. Knee laxity measurements were compared between two groups using unpaired Student's t test.ResultsRamp lesions were observed in 30 patients (14.7%). Subsequently, 17 patients were allocated to ‘ramp group’ and 77 patients to ‘control group’, and there were no statistical differences with regard to background demographics. ATT‐SSD during Lachman test was significantly greater in ‘ramp group’ (9.1 [95% confidence interval, CI: 5.7–12.5] mm vs. 6.2 [95% CI: 5.1–7.3] mm, p = 0.037). However, SSD in ATT with KT‐2000, tibial acceleration during pivot‐shift test, and SSD in tibial rotational angles were not significantly different between the two groups.ConclusionPresence of ramp lesion was associated with increased anterior knee laxity during Lachman test, suggesting ramp lesions may need to be addressed at the time of ACL reconstruction.Level of EvidenceIV.

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Does meniscus removal affect ACL-deficient knee laxity? An in vivo study

Abstract: The present study shows that meniscal defects significantly affect the kinematics of an ACL-deficient knee in terms of anterior tibial translation under static and dynamic testing.

Cited by 28 publications

References 24 publications

Influence of meniscal repair versus meniscectomy on ACL reconstruction in terms of knee stability and radiological imaging

Influence of meniscal repair versus meniscectomy on ACL reconstruction in terms of knee stability and radiological imaging

The Contribution of Partial Meniscectomy to Preoperative Laxity and Laxity After Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction: In Vivo Kinematics With Navigation

Ramp lesions of the medial meniscus are associated with greater preoperative anterior knee laxity in anterior cruciate ligament injury

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