Posterior Lateral Meniscal Root Tears Increase Strain on the Reconstructed Anterior Cruciate Ligament: A Cadaveric Study

Uffmann, William; ElAttrache, Neal S.; Nelson, Trevor; Eberlein, Sam A.; Wang, Juntian; Howard, Daniel R.; Metzger, Melodie F.

doi:10.1016/j.asmr.2020.11.005

Cited by 11 publications

(12 citation statements)

References 30 publications

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“…The association between SSD‐ATT and MRI‐confirmed meniscus tears in the present study is supported by several radiographic [27], MRI [28] and biomechanical studies [10, 13]. Other studies have clearly identified the role of the menisci, especially the medial meniscus, as major contributors in anterior tibial translation restraint [11, 36]. Previous studies [7] failed to identify this association in standard lateral weightbearing radiographs but demonstrated that ATT measured in stress radiographs was influenced by the presence and type of meniscal tears.…”

Section: Discussionsupporting

confidence: 85%

Side-to-side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL-deficient knees

Macchiarola

Jacquet

Dor

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the influence of time from injury and meniscus tears on the side-to-side difference in anterior tibial translation (SSD-ATT) as measured on lateral monopodal weightbearing radiographs in both primary and secondary ACL deficiencies. Methods Data from 69 patients (43 males/26 females, median age 27-percentile 25-75: 20-37), were retrospectively extracted from their medical records. All had a primary or secondary ACL deficiency as confirmed by MRI and clinical examination, with a bilateral weightbearing radiograph of the knees at 15°-20° flexion available. Meniscal status was assessed on MRI images by a radiologist and an independent orthopaedic surgeon. ATT and posterior tibial slope (PTS) were measured on the lateral monopodal weightbearing radiographs for both the affected and the contralateral healthy side. A paired t-test was used to compare affected/healthy knees. Independent t-tests were used to compare primary/secondary ACL deficiencies, time from injury (TFI) (≤ 4 years/ > 4 years) and meniscal versus no meniscal tear. Results ATT of the affected side was significantly greater than the contralateral side (6.2 ± 4.4 mm vs 3.5 ± 2.8 mm; p < 0.01). There was moderate correlation between ATT and PTS in both the affected and healthy knees (r = 0.43, p < 0.01 and r = 0.41, p < 0.01). SSD-ATT was greater in secondary ACL deficiencies (4.7 ± 3.8 vs 1.9 ± 3.2 mm; p < 0.01), patients with a TFI greater than 4 years (4.2 ± 3.8 vs 2.0 ± 3.0 mm; p < 0.01) and with at least one meniscal tear (3.9 ± 3.8 vs 0.7 ± 2.2 mm; p < 0.01). Linear regression showed that, in primary ACL deficiencies, SSD-ATT was expected to increase (+ 2.7 mm) only if both a meniscal tear and a TFI > 4 years were present. In secondary ACL deficiencies, SSD-ATT was mainly influenced by the presence of meniscal tears regardless of the TFI. Conclusion SSD-ATT was significantly greater in secondary ACL deficiencies, patients with a TFI greater than 4 years and with at least one meniscal tear. These results confirm that SSD-ATT is a time-and meniscal-dependent parameter, supporting the concept of gradual sagittal decompensation in ACL-deficient knees, and point out the importance of the menisci as secondary restraints of the anterior knee laxity. Monopodal weightbearing radiographs may offer an easy and objective method for the follow-up of ACL-injured patients to identify early signs of soft tissue decompensation under loading conditions. Level of evidence Level III.

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Section: Discussionsupporting

confidence: 85%

Side-to-side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL-deficient knees

Macchiarola

Jacquet

Dor

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…Three biomechanical studies reporting outcomes after LMPR repair in the setting of an ACLR in 35 human specimens were identified (Table 1) [11, 32, 34]. All included studies used the transtibial pullout repair method, with 2/3 studies reporting use of 2 transtibial tunnels [11, 32].…”

Section: Resultsmentioning

confidence: 99%

“…Overall, the included biomechanical studies reported that pullout repair of the LMPR improved lateral compartment joint contact pressures and restored joint mechanics to intact levels. Furthermore, the studies reported restoration of joint biomechanics [11] and graft strain forces at 15° and 30° of lexion [34] to the intact state following LMPR repair, with two of these studies reporting inconsistent improvement in anterior tibial translation (ATT) following LMPR repair and ACLR when compared to the intact state [32,34]. 2).…”

Section: Biomechanical Outcomes Following Lmpr Repairmentioning

confidence: 99%

Lateral meniscus posterior root repair in the setting of anterior cruciate ligament reconstruction restores joint mechanics to the intact state and improves clinical function: a systematic review of biomechanical and clinical outcomes

Perry

Knapik

Maheshwer

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To perform a systematic review of biomechanical and clinical outcomes following lateral meniscus posterior root (LMPR) repair with concomitant anterior cruciate ligament reconstruction (ACLR). Methods A literature search was performed systematically using PubMed, Embase, and Medline databases in April 2022. The search included the following terms combined with Boolean operators: 'Meniscus repairs', 'Meniscal Repair', 'Posterior Horn', 'Root', 'Radial'. Inclusion criteria consisted of level I-IV human clinical and biomechanical studies reporting biomechanical data and/or outcomes following LMPR repair in the setting of ACLR. Results Three biomechanical studies, all utilizing a transtibial pullout technique, were identiied, all of which reported signiicant improvement in joint contact pressures and mechanics and 3/4 of which reported signiicant improvement in anterior or rotational stability with LMPR repair. Five clinical studies, consisting of 146 patients (mean age 28.5 ± 1.1 years) undergoing LMPR repair, were identiied with an average follow-up of 19.1 months (range 6.2-46 months). Across all clinical studies, Lysholm and International Knee Documentation Committee (IKDC) scores were found to improve postoperatively, with 3/4 reporting signiicant improvement in Lysholm (all, p ≤ 0.001) scores and 3/5 reporting signiicant improvement in IKDC scores when compared to preoperative values (all, p ≥ 0.004). Meniscal extrusion decreased signiicantly following repair in 2/4 studies (all, p ≤ 0.001). Conclusions Biomechanically, transtibial pullout repair of the LMPR restored joint contact pressures and joint mechanics to intact levels when performed with concomitant ACLR. Clinically, LMPR repair with concurrent ACLR resulted in improved Lysholm and IKDC scores. These indings enable surgeons to determine optimal treatment plans and discuss realistic outcomes with patients when encountering LMPR injuries. Level of evidence IV.

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“…Meniscal injury results in increased anterior tibial translation 34 , rotational instability, altered kinematics, and increased contact pressures within the affected compartment 33 . Biomechanical studies have shown significant increases in anterior tibial translation, rotational laxity, and pivot shift grade in ACL-deficient knees with concurrent LMPRT, MMRL, or meniscectomies 28,31,[35][36][37][38] . In particular, the biomechanical consequences of meniscal root injuries continue to be elucidated as, even with an intact ACL, LMPRT increases the rotational instability of the knee 35 .…”

Section: Meniscal Injurymentioning

confidence: 99%

New Considerations in ACL Surgery

Baker

Bowen

Sheean

et al. 2023

Journal of Bone and Joint Surgery

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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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Posterior Lateral Meniscal Root Tears Increase Strain on the Reconstructed Anterior Cruciate Ligament: A Cadaveric Study

Cited by 11 publications

References 30 publications

Side-to-side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL-deficient knees

Side-to-side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL-deficient knees

Lateral meniscus posterior root repair in the setting of anterior cruciate ligament reconstruction restores joint mechanics to the intact state and improves clinical function: a systematic review of biomechanical and clinical outcomes

New Considerations in ACL Surgery

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