The Presence of the Arthroscopic “Floating Meniscus” Sign as an Indicator for Surgical Intervention in Patients With Combined Anterior Cruciate Ligament and Grade II Medial Collateral Ligament Injury

Funchal, Luis Fernando Zukanovich; Astur, Diego Costa; Ortiz, Rafael Trevisan; Cohen, Moisés

doi:10.1016/j.arthro.2018.10.114

Cited by 39 publications

(42 citation statements)

References 19 publications

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“… 20 In the past, residual valgus laxity was the major concern with MCL injuries 21 , 22 ; however, MCL injuries may include the meniscotibial coronary ligaments and impair the function of the medial meniscus, resulting in a floating meniscus. 23 Both the medial meniscus and MCL are secondary restraints to anterior tibial translation, 24 , 25 and performing an ACLR without addressing these injuries would add more strain to the reconstructed ACL graft, increasing the chance of reinjury. 23 , 26 Therefore, MCL repair in higher-grade injuries is important; it will restore medial meniscal function and protect the ACL graft.…”

Section: Discussionmentioning

confidence: 99%

“… 23 Both the medial meniscus and MCL are secondary restraints to anterior tibial translation, 24 , 25 and performing an ACLR without addressing these injuries would add more strain to the reconstructed ACL graft, increasing the chance of reinjury. 23 , 26 Therefore, MCL repair in higher-grade injuries is important; it will restore medial meniscal function and protect the ACL graft. There is agreement on surgical intervention for Stener-like lesions of the distal MCL tibial attachment in which the ligament becomes entrapped superficial to the hamstring insertion, preventing healing.…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous Arthroscopic Assisted Knee Medial Collateral Ligament Repair

Jacob

A.N

Kumar

et al. 2020

Arthroscopy Techniques

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Medial collateral ligament (MCL) injuries are commonly encountered alongside anterior cruciate ligament injuries. Treatment modalities have ranged from conservative management to surgical repair, augmentation, and reconstruction. Various reports have reported residual valgus instability, especially in higher-grade injuries that have been treated conservatively. The MCL provides valgus stability but also is an element of anterior stability to the tibia in addition to the anterior cruciate ligament. In addition, meniscal “lift-off” and “floating” have been described as consequences after MCL injuries, and meniscal dysfunction has been shown to lead to accelerated joint degeneration; therefore, all efforts should be made to treat these injuries adequately. We describe a simple, minimally invasive technique that involves suturing the deep MCL to the medial joint capsule, allowing better MCL healing, causing less soft-tissue scarring, and preventing meniscal extrusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Percutaneous Arthroscopic Assisted Knee Medial Collateral Ligament Repair

Jacob

A.N

Kumar

et al. 2020

Arthroscopy Techniques

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“…ACL injury associated with capsular-ligamentous injuries of the medial portion of the knee is very frequent, and when medial laxity persists, the load carried by the ACL graft increases 9,16,17 . This residual medial instability may result in failure of ACL reconstruction 18,19,20 . AMRI certainly participates in the causes of ACL failure, generated by medial compartment failure.…”

Section: Discussionmentioning

confidence: 99%

“…After identi cation of the structure, a histological and radiological MRI study was initiated (AOL visualized in x examined specimens). The authors studied the anatomy and biomechanics of the region 5,8,9,10,16,17,18,19,21,22 and developed a reasoning termed the Theory of Tibial Quadrants, which facilitates the understanding of circumferential joint structures and rotational control (Figure 4). The tibial surface is divided into an anterior and posterior portion through a band that connects the femoral transepicondylar plane, the origin or near origin of the important ligaments that travel toward the tibia.…”

Section: Discussionmentioning

confidence: 99%

The Anterior Oblique Ligament description in the knee anteromedial compartment

Jorge¹,

Oliveira²,

Resende³

et al. 2020

Preprint

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Purpose: To describe a ligamentous structure in the anteromedial region of the knee identified in a series of anatomical dissections of cadaveric specimens.Methods: Sixteen cadaveric knees were dissected to study the medial compartment. Exclusion criteria were signs of trauma, previous surgery, signs of osteoarthritis and poor preservation state. The main structures of this region were identified during medial dissection. After releasing the superficial medial collateral ligament (sMCL) of the tibia, the Anterior Oblique Ligament (AOL), was isolated. The morphology of the structure and its relationship with known anatomical parameters were determined. For the statistical analysis, the means and standard deviations were calculated for continuous variables. A 95% confidence intervals was defined as significant. Student's t-tests were used for continuous variables.Results: After dissection a distinct ligamentous structure (AOL) was found in the medial region of the knee. This structure was found in 100% of the cases, was located extracapsularly and originated in the anterior aspect of the medial epicondyle, running obliquely toward the tibia. When crossing the joint, the ligament presented a fan-shaped opening, exhibiting a larger area at the tibial insertion. The AOL had a mean thickness of 6.83±1.34 mm at its femoral origin and 13.06±1.91 at its tibial insertion. It had a significantly (p = 0.0009) longer mean length with the knee at 90° of flexion (33.82±9.50 mm) than with the knee in total extension (26.56±9.48 mm), indicating that the ligament is tensioned in flexion.Conclusion: A structure was identified in the anteromedial compartment of the knee with a ligamentous appearance originating in the medial femoral epicondyle and with tibial insertion anterior to the sMCL. Clinical relevance: This study demonstrates the anatomy of a new medial structure of the knee. As a result, there will be a better understanding of the stability of the knee.

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“…, this manifests as understanding that a floating meniscus indicates deep MCL injury. "6 Our other finalists are included inTable 1 5,[7][8][9][10]. Basic Science Research Excellence AwardWinners Histologic, and Molecular Evaluation of Tendon Healing in a New Murine Model of Rotator Cuff Repair.…”

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confidence: 99%