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

Abstract

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.

The Lateral Femoral Notch Sign Is Correlated With Increased Rotatory Laxity After Anterior Cruciate Ligament Injury: Pivot Shift Quantification With A Surgical Navigation System

“…The PS is a multifactorial phenomenon, and different bone morphological variations as well as soft tissue lesions, such as lateral meniscal tears, 7,18,19 influence its magnitude. Many studies have focused on the effect of physiological osseous variations such as a steep lateral tibial plateau slope 31 and increased femoral condyle ratio.…”

“…To evaluate joint laxity, the authors opted for a surgical navigation system (BLU-IGS; Orthokey) equipped with software dedicated to intraoperative kinematic acquisitions (KLEE; Orthokey) (Figure 1). Once the anatomic bony landmarks were identified, the same senior orthopaedic surgeon, with an experience of more than 200 navigated ACLRs, 7 performed the PS test under anesthesia following a standardized maneuver. 9,29 The examination protocol was performed by utilizing the method developed by Martelli et al 22,23 The PS test was quantified, according to the literature, 28 through 2 different parameters: the posterior acceleration of the lateral tibial compartment during tibial reduction (PS ACC) and the internal-external rotation (PS IE).…”

Meniscal Allograft Transplantation After Anterior Cruciate Ligament Reconstruction Can Improve Knee Stability: A Comparison of Medial and Lateral Procedures

“…In this study, after ACL reconstruction and total or nearly total meniscectomy of the meniscus, there was 6.5 mm of STSD in the medial MAT group versus only 2.3 mm in the lateral MAT group. Similarly, Grassi et al 3 reported residual anterior translation in patients with ACL reconstruction and partial medial meniscectomy. The present study has shown that medial MAT can restore preoperative anteroposterior instability.…”

Ten-Year Survivorship, Patient-Reported Outcome Measures, and Patient Acceptable Symptom State After Over-the-Top Hamstring Anterior Cruciate Ligament Reconstruction With a Lateral Extra-articular Reconstruction: Analysis of 267 Consecutive Cases

“…This supports what Parkinson et al 29 reported, which was a higher risk of ACL failure in patients with medial meniscal deficiency. From a biomechanical point of view, medial meniscal removal 16 generates postoperative laxity during static and dynamic tasks, which could be deleterious for ACL graft survival. Of note, a similar effect was suggested after meniscal repair as well.…”

“…All patients underwent the same surgical procedure, which consisted of a single-bundle over-the-top ACL reconstruction and lateral extra-articular reconstruction using single-strand gracilis and semitendinosus hamstring tendon autografts. 16 After the gracilis and semitendinosus tendons were harvested, with their tibial attachments preserved, the single-strand tendons were passed through the tibial tunnel and over the top of the femur. A groove was made with an osteotome on the lateral aspect of the lateral condyle of the femur to freshen the bone to enhance healing of the graft while aiding in graft stabilization.…”