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.
SourceAvailable from: Robert F LaPrade[Show abstract] [Hide abstract]
ABSTRACT: Posterior root avulsions of the medial and lateral menisci result in decreased areas of tibiofemoral contact and increased tibiofemoral contact pressures. These avulsions may lead to the development of osteoarthritis. Therefore, two surgical techniques, the transtibial pullout repair and the suture anchor repair, have recently been developed to restore the native structure and function of the meniscal root attachment. Compared with the historical alternative of partial or total meniscectomy, these techniques allow for meniscal preservation and anatomic reduction of the meniscal roots, with the goal of preventing the development and progression of osteoarthritis. However, early biomechanical and clinical studies have reported conflicting results on the effectiveness of both techniques with regard to resisting displacement and facilitating healing. Although there is currently a lack of consensus on which is the superior technique, transtibial pullout and suture anchor repairs are increasingly used in clinical practice.The Journal of the American Academy of Orthopaedic Surgeons 01/2015; 23(2):71-76. DOI:10.5435/JAAOS-D-14-00003 · 2.40 Impact Factor
Article: What's New in Sports MedicineThe Journal of Bone and Joint Surgery 04/2014; 96(8):695-702. DOI:10.2106/JBJS.M.01569 · 4.31 Impact Factor
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ABSTRACT: Purpose Posterior lateral meniscus root tears (PLMRTs) affect the intra-articular pressure distribution in the lateral compartment of the knee. The biomechanical consequences of these injuries are significantly influenced by the integrity of the meniscofemoral ligaments (MFLs). A newly introduced arthroscopic classification system for PLMRTs that takes MFL integrity into account has not yet been clinically applied but may be useful in selecting the optimal method of PLMRT repair. Methods Prospective ACL reconstruction data were collected. Concomitant injuries of the lateral meniscus posterior horn were classified according to their shape and MFL status. The classifications were: type 1, avulsion of the root; type 2, radial tear of the lateral meniscus posterior horn close to the root with an intact MFL; and type 3, complete detachment of the posterior meniscus horn. Results Between January 2011 and May 2012, 228 consecutive ACL reconstructions were included. Lateral and medial meniscus tears were identified in 38.2 % (n = 87) and 44.7 % (n = 102), respectively. Of the 87 lateral meniscus tears, 32 cases had PLMRTs; the overall prevalence of PLMRTs was 14 % (n = 32). Two medial meniscus root tears were detected. All PLMRTs were classified according to the classification system described above, and the fixation procedure was adapted to the type of meniscus tear. Conclusion The PLMRT tear is a common injury among patients undergoing ACL repair and can be arthroscopically classified into three different types. Medial meniscus root tears are rare in association with ACL tears. The PLMRT classification presented here may help to estimate the injury’s impact on the lateral compartment and to identify the optimal treatment. These tears should not be overlooked, and the treatment strategy should be chosen with respect to the type of root tear. Level of evidence IV.Knee Surgery Sports Traumatology Arthroscopy 12/2014; 23(1). DOI:10.1007/s00167-014-3467-6 · 2.84 Impact Factor