Repair of Lateral Meniscus Posterior Horn Detachment Lesions A Biomechanical Evaluation
ABSTRACT BACKGROUND:Posterior horn detachment (PHD) lesions of the lateral meniscus are commonly associated with acute anterior cruciate ligament (ACL) tears. Multiple surgeons have advocated for repair of this lesion at the time of ACL reconstruction. However, the biomechanical consequences of this lesion and its subsequent repair have not been evaluated. HYPOTHESIS:The PHD lesion of the lateral meniscus will lead to increased tibiofemoral contact pressures, and repair of this lesion to bone via a tibial tunnel can restore normal contact pressures during simulated gait. STUDY DESIGN:Controlled laboratory study. METHODS:Lateral compartment contact pressures were measured via a sensor on the tibial plateau in 8 cadaver knees with the knee intact, after sectioning the posterior horn of the lateral meniscus to simulate PHD, and after repairing the injury. The repair was performed using an ACL tunnel guide to drill a tunnel from the anteromedial tibia to the posterior horn attachment site. Dynamic pressure data were continuously collected using a conductive ink pressure sensing system while each knee was moved through a physiological gait flexion cycle. RESULTS:Posterior horn detachment caused a significant increase in tibiofemoral peak contact pressure from 2.8 MPa to 4.2 MPa (P = .03). After repair of the lesion to bone was performed through a transtibial tunnel, the peak contact pressure was 2.9 MPa. Posterior horn detachment also significantly decreased the maximum contact area over which tibiofemoral pressure is distributed from 451 mm(2) in the intact state to 304 mm(2) in the detached state. Repair of the PHD lesion increased the maximum contact area to 386 mm(2), however, this area was also significantly less than in the intact state (P = .05). CONCLUSION:Posterior horn detachment of the lateral meniscus causes increased peak tibiofemoral contact pressure. The peak pressure can be reduced to a normal level with repair of the lesion to bone via a transtibial tunnel. CLINICAL RELEVANCE:Posterior horn detachment of the lateral meniscus is a lesion often associated with an acute ACL tear. Debate exists concerning the importance of repairing PHD lesions at the time of ACL reconstruction. The data provided in this study may influence surgeons' management of the lesion.
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ABSTRACT: Context:Magnetic resonance imaging (MRI) affords high-resolution visualization of the soft tissue structures (menisci, ligaments, cartilage, etc) and bone marrow of the knee.Evidence Acquisition:Pertinent clinical and research articles in the orthopaedic and radiology literature over the past 30 years using PubMed.Results:Ligament tears can be accurately assessed with MRI, but distinguishing partial tears from ruptures of the anterior cruciate ligament (ACL) can be challenging. Determining the extent of a partial tear is often extremely difficult to accurately assess. The status of the posterolateral corner structures, menisci, and cartilage can be accurately evaluated, although limitations in the evaluation of certain structures exist. Patellofemoral joint, marrow, tibiofibular joint, and synovial pathology can supplement physical examination findings and provide definitive diagnosis.Conclusions:MRI provides an accurate noninvasive assessment of knee pathology.Sports Health A Multidisciplinary Approach 01/2013; 5(1):78-107. DOI:10.1177/1941738112468416
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ABSTRACT: Injuries of the meniscus roots have become increasingly recognised as a serious pathology of the knee joint. However, the current available literature focuses primarily on posterior meniscus root tears. In this article, a case with an isolated avulsion of the anterior medial meniscus root is presented, and a new arthroscopic technique to treat this type of injury is described. The anterior horn of the medial meniscus was sutured with a double-looped nonabsorbable suture and reattached to the tibial plateau using a knotless suture anchor. This technique may also be useful to treat avulsion injuries of the anterolateral or posteromedial meniscus root, and symptomatic subluxation of the medial meniscus in case of a variant insertion anatomy with an absent attachment of the anterior horn of the medial meniscus to the tibial plateau. Level of evidence V.Knee Surgery Sports Traumatology Arthroscopy 03/2013; 23(1). DOI:10.1007/s00167-013-2462-7 · 2.84 Impact Factor
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ABSTRACT: ObjectiveMagnetic resonance imaging (MRI) findings in anterior cruciate ligament (ACL) injury are well known, but most published reviews show obvious examples of associated injuries and give little focus to paediatric patients. Here, we demonstrate the spectrum of MRI appearances at common sites of associated injury in adolescents with ACL tears, emphasising age-specific issues.MethodsPictorial review using images from children with surgically confirmed ACL tears after athletic injury.ResultsACL injury usually occurs with axial rotation in the valgus near full extension. The MRI findings can be obvious and important to management (ACL rupture), subtle but clinically important (lateral meniscus posterior attachment avulsion), obvious and unimportant to management (femoral condyle impaction injury), or subtle and possibly important (medial meniscocapsular junction tear). Paediatric-specific issues of note include tibial spine avulsion, normal difficulty visualising a thin ACL and posterolateral corner structures, and differentiation between incompletely closed physis and impaction fracture.ConclusionACL tear is only the most obvious sign of a complex injury involving multiple structures. Awareness of the spectrum of secondary findings illustrated here and the features distinguishing them from normal variation can aid in accurate assessment of ACL tears and related injuries, enabling effective treatment planning and assessment of prognosis.Teaching points• The ACL in children normally appears thin or attenuated, while thickening and oedema suggest tear.• Displaced medial meniscal tears are significantly more common later post-injury than immediately.• The meniscofemoral ligaments merge with the posterior lateral meniscus, complicating tear assessment.• Tibial plateau impaction fractures can be difficult to distinguish from a partially closed physis.• Axial MR sequences are more sensitive/specific than coronal for diagnosis of medial collateral ligament (MCL) injury.05/2013; 4(3). DOI:10.1007/s13244-013-0250-z