The effect of medial meniscal horn injury on knee stability (original) (raw)
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Knee surgery & related research, 2017
Cadaveric studies have shown that deficiency of the posterior horn of the medial meniscus (PHMM) increases strain on the anterior cruciate ligament (ACL) graft. However, its influence on the clinical and radiological outcome after ACL reconstruction is less discussed and hence evaluated in this study. This study included 77 cases of ACL reconstruction with a minimum 18-month follow-up. Of the 77 cases, 41 patients with intact menisci were compared clinically and radiologically with 36 patients with an injury to the PHMM that required various grades of meniscectomy. The knees were evaluated using subjective International Knee Documentation Committee (IKDC) score and Orthopadische Arbeitsgruppe Knie (OAK) score. Cases with intact menisci showed better stability (p=0.004) at an average of 44.51 months after surgery. No significant differences were noted in the overall OAK score, subjective IKDC score, and functional OAK score (p=0.082, p=0.526, and p=0.363, respectively). The incidence...
Orthopaedics & traumatology: surgery & research, 2020
Introduction: There is considerable debate regarding the function of anterolateral knee structures, including the anterolateral ligament (ALL) and anterolateral capsule, as knee stabilizers in anterior cruciate ligament (ACL) injured knees. Medial meniscus posterior horn (MMPH) injuries have also been associated with increased knee laxity in ACL injured knees. The purpose of this cadaveric biomechanical study was to compare the effects of the anterolateral complex (ALC) injury and meniscectomy of MMPH on knee laxity in ACL injured knees. Hypothesis: ALC injury would have a greater effect on internal rotational laxity in ACL-injured knee than meniscectomy of MMPH. Material and methods: Matched-pair 10 fresh-frozen cadaveric knees underwent biomechanical evaluation of knee laxity. After testing the intact knee and ACL sectioned knee (ACL-) in matched-pair 10 fresh-frozen cadaveric knees, two groups were established: an ALC sectioning (ACL-/ALC-) group (n = 5) and a MMPH meniscectomy (ACL-/MMPH-) group (n = 5). Knee laxity was measured in terms of internalexternal rotation, anterior-posterior translation, and varus-valgus angulation for each condition at knee flexion angles of 0 • , 30 • , 60 • and 90 •. Results: After the additional sectioning of the ALC (ACL-/ALC-), the mean internal rotation at 0 • , 30 • , 60 • and 90 • of knee flexion showed the greater internal rotation laxity compared than intact knee (p = 0.020, 0.011, 0.005 and < 0.001). It also significantly increased anterior translation from ACL-at 30 • and 60 • (p = 0.011 and 0.005). In contrast, additional meniscectomy of the MMPH (ACL-/MMPH-) significantly increased external rotation laxity compared to intact knee (p = 0.021, 0.018 and 0.024) and ACL-(p = 0.037, 0.011 and 0.025) at 30 • , 60 • and 90 •. ACL-/MMPH-also resulted in significantly increased anterior translation from ACL-at 30 • , 60 • and 90 • (p = 0.004, 0.008 and 0.002). Discussion: In conclusion, the anterolateral complex, which include the ALL and anterolateral capsule, may play an important role in stabilizing the knee against internal rotation and anterior translation, while the MMPH may contribute to resisting external rotation and anterior translation stability in ACL-injured knee.
Knee, 2020
Introduction: There is considerable debate regarding the function of anterolateral knee structures, including the anterolateral ligament (ALL) and anterolateral capsule, as knee stabilizers in anterior cruciate ligament (ACL) injured knees. Medial meniscus posterior horn (MMPH) injuries have also been associated with increased knee laxity in ACL injured knees. The purpose of this cadaveric biomechanical study was to compare the effects of the anterolateral complex (ALC) injury and meniscectomy of MMPH on knee laxity in ACL injured knees. Hypothesis: ALC injury would have a greater effect on internal rotational laxity in ACL-injured knee than meniscectomy of MMPH. Material and methods: Matched-pair 10 fresh-frozen cadaveric knees underwent biomechanical evaluation of knee laxity. After testing the intact knee and ACL sectioned knee (ACL-) in matched-pair 10 fresh-frozen cadaveric knees, two groups were established: an ALC sectioning (ACL-/ALC-) group (n = 5) and a MMPH meniscectomy (ACL-/MMPH-) group (n = 5). Knee laxity was measured in terms of internalexternal rotation, anterior-posterior translation, and varus-valgus angulation for each condition at knee flexion angles of 0 • , 30 • , 60 • and 90 •. Results: After the additional sectioning of the ALC (ACL-/ALC-), the mean internal rotation at 0 • , 30 • , 60 • and 90 • of knee flexion showed the greater internal rotation laxity compared than intact knee (p = 0.020, 0.011, 0.005 and < 0.001). It also significantly increased anterior translation from ACL-at 30 • and 60 • (p = 0.011 and 0.005). In contrast, additional meniscectomy of the MMPH (ACL-/MMPH-) significantly increased external rotation laxity compared to intact knee (p = 0.021, 0.018 and 0.024) and ACL-(p = 0.037, 0.011 and 0.025) at 30 • , 60 • and 90 •. ACL-/MMPH-also resulted in significantly increased anterior translation from ACL-at 30 • , 60 • and 90 • (p = 0.004, 0.008 and 0.002). Discussion: In conclusion, the anterolateral complex, which include the ALL and anterolateral capsule, may play an important role in stabilizing the knee against internal rotation and anterior translation, while the MMPH may contribute to resisting external rotation and anterior translation stability in ACL-injured knee.
Effect of Posterior Horn Medial Meniscus Root Tear on In Vivo Knee Kinematics
Orthopaedic Journal of Sports Medicine, 2014
Background: Medial meniscus root tear (MMRT) is a recently recognized yet frequently missed meniscal tear pattern that biomechanically creates an environment approaching meniscal deficiency. Hypothesis/Purpose: The purpose of this study was to assess the effect of MMRT on tibiofemoral kinematics and arthrokinematics during daily activities by comparing the injured knees of subjects with isolated MMRT to their uninjured contralateral knees. The hypothesis was that the injured knee will demonstrate significantly more lateral tibial translation and adduction than the uninjured knee, and that the medial compartment will exhibit significantly different arthrokinematics than the lateral compartment in the affected limb. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Seven subjects with isolated MMRT were recruited and volumetric, density-based 3-dimensional models of their distal femurs and proximal tibia were created from computed tomography scans. High-speed, biplan...
The Knee, 2018
Background: The role of an intact meniscus in providing mechanical stability to the knee of anterior cruciate ligament (ACL) deficient and ACL reconstructed patients has not been well studied. Methods: This was a prospective cohort study. A total of 205 patients undergoing ACL reconstruction were enrolled, of which 61 had normal menisci, 49 had a tear in the posterior horn of the medial meniscus (PHMM) (tear b40% of width = 19; N 40% of width = 30), 35 had a tear in the lateral meniscus (b 40% of width = 15; N40% = 20), 13 had a tear in the body and/or anterior horn of the medial meniscus (b40% of width = 6; N40% = 7) and 47 patients had a tear in both menisci. Patients with a tear in both menisci were excluded. The anterior translation of the tibia (ATT) was calculated preoperatively and postoperatively at three months and six months using KT-1000. Partial meniscectomy was performed in all unstable meniscal tears. Results: The mean age at the time of surgery was 25.2 ± 5.1 years. Patients with a normal meniscus showed side to side difference in KT-1000 of 4.8 ± 2.5 mm whereas those with a b 40% tear and N 40% tear in PHMM had a difference of 5.36 ± 3.07 mm (P = 0.46) and 7.08 ± 2.78 mm (P = 0.0002), respectively. Patients with a lateral meniscus b 40% and N40% tear had a mean difference of 5.68 ± 2.96 mm (P = 0.22) and 5.95 ± 2.39 mm (P = 0.09), respectively. Patients with body and/or anterior horn of medial meniscus b40% and N 40% had a difference of 5.41 ± 1.11 mm (P = 0.59) and 5.78 ± 2.38 mm (P = 0.35), respectively. At three months and six months KT-1000 differences of 2.3 ± 1.2 mm and 2.1 ± 1.2 mm were seen in patients with normal meniscus; 2.26 ± 1.51 mm and 2.16 ± 0.9 mm with partial meniscectomy of the PHMM b40%; 2.65 ± 1.53 mm and 2.4 ± 1.35 mm with partial meniscectomy of the PHMM N 40%; 2.27 ± 1.19 mm and 2.07 ± 1.52 mm with partial meniscectomy of the lateral meniscus b 40%; and 2.27 ± 1.44 mm and 2.07 ± 1.14 mm with partial meniscectomy of the lateral meniscus N40%; 2.55 ± 1.56 mm and 1.91 ± 1.09 mm with partial meniscectomy in body and/or anterior horn of medial meniscus b 40% and 2.07 ± 1.81 and 2.14 ± 1.10 mm with partial meniscectomy in body and/or anterior horn of medial meniscus N40% (P N 0.05). Conclusion: PHMM acts as a secondary stabilizer of the knee joint in the absence of functional ACL. There is no effect of partial meniscectomy on mechanical stability of the knee in ACL reconstructed patients. Medial or lateral partial meniscectomy performed at the time of ACL reconstruction does not affect the stability of ACL reconstructed knee. However, the presence of a concomitant tear in PHMM is associated with increased instability in ACL deficient knee.
The insertion of the anterior horn of the medial meniscus: an anatomic study
Muscles, ligaments and tendons journal, 2013
The purpose of this study was to identify the various patterns of insertion of the anterior horn of the medial meniscus in Ghanaian subjects. The study involved 35 cadaveric knees (26 males and 9 females). Berlet and Fowler classification was used to classify the insertion of the anterior horn of the medila meniscus. The distribution of the insertion pattern was as follows; 42.9% (15) had type I insertion, 45.7% (16) had type II, type III and IV insertions were each found in 5.7% (2) of the dissected knees. Type II insertion had the highest incidence which was a deviation from what has been reported in literature. The incidence of the anterior intermeniscal ligament (AIML) was 34.3%, which was much lower that most studies have reported. The findings of the study may suggest that the pattern of insertion of the anterior horn of the medial meniscus may be different in the Ghanaian population; further research is needed in this area.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2014
Purpose: To evaluate the effect of the meniscofemoral ligament (MFL) in maintaining lateral-compartment contact pressures after injury to the posterior root of the lateral meniscus, and to measure the ability to restore intra-articular loads to normal by repairing the posterior root to the tibia after transection of the posterior root and the MFL. Methods: Ten human cadaveric knee joints were axially loaded to 100 N. A digital pressure sensor measured the contact pressure in the lateral compartment. Five different conditions were tested: intact, after release of the posterior root of the lateral meniscus, after transection of the MFL along with release of the posterior root, refixation of the posterior root of the lateral meniscus to the tibia using an anatomic transosseous tunnel, and refixation of the root of the lateral meniscus using a tibial anterior cruciate ligament (ACL) tunnel. Results: After transection of the posterior lateral meniscus root, the contact pressure did not increase significantly. The additional transection of the MFL led to a significant increase in the contact pressure. Anatomic fixation of the meniscus posterior horn reduced the femorotibial pressure to nearly pre-sectioning values. The reattachment of the meniscus posterior horn through a tibial ACL tunnel was equivalent to an anatomic fixation. Conclusions: In the case of a root tear of the lateral meniscus, the MFL maintains meniscus function and stabilizes the pressure in the lateral compartment. A complete detachment of the posterior meniscus horn (MFL and root tear) leads to an increase in the intra-articular pressure. A root repair normalizes the pressure down to normal values. The tibial ACL tunnel is suitable to perform the repair and to lead out the suture. Clinical Relevance: In the case of a complete detachment of the meniscus posterior horn, fixation of the posterior root is necessary to restore the meniscus function and to guarantee an equal pressure distribution in the lateral compartment. It can be combined with an ACL reconstruction. T he knee joint menisci increase femorotibial congruency, and they contribute significantly to load transmission and joint stability. During load transmission, the forces acting on the meniscus are transformed into circumferential hoop stress. 1 This circular hoop stress is transmitted to the tibial plateau by the anterior and posterior roots of the menisci. 1 Therefore From the Klinik für Orthopädie und Unfallchirurgie,
Anterior Horn Tears of the Lateral Meniscus in Soccer Players
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2006
The purpose of this retrospective study was to define the clinical and arthroscopic characteristics of anterior horn tears of the lateral meniscus. Type of Study: Case series. Methods: Fourteen patients with mean age of 20.2 years were enrolled in this institutional review boardapproved study. All patients were soccer players with tears of the anterior horn of the lateral meniscus. All patients underwent physical examinations, magnetic resonance imaging (MRI), and arthroscopic treatment. Results: Common symptoms were a catching sensation in 10 patients (71.4%), pain at squatting in 9 patients (64.3%), and sense of giving way and effusion, each in 7 patients (50%). Five patients (35.7%) had lateral joint-line tenderness. McMurray's test was positive in 6 (42.9%) and tears were diagnosed by MRI in 13 (92.8%) patients. Arthroscopic examination showed multiple longitudinal tears in the avascular white zone of the meniscus in 7 patients (50%). Conclusions: These data show that the McMurray test and joint-line tenderness had a low diagnostic value in diagnosing anterior horn tears of the lateral meniscus. MRI, however, had a high diagnostic value. Common arthroscopic findings included multiple longitudinal tears within the white zone of the anterior horn. Level of Evidence: Level IV.