Original Article
The Effect of Anterior Cruciate Ligament Reconstruction on Kinematics of the Knee With Combined Anterior Cruciate Ligament Injury and Subtotal Medial Meniscectomy: An In Vitro Robotic Investigation

https://doi.org/10.1016/j.arthro.2008.09.020Get rights and content

Purpose

The aims of this study were to determine: (1) the kinematic effect of subtotal medial meniscectomy on the anterior cruciate ligament (ACL)–deficient knee and (2) the effect of ACL reconstruction on kinematics of the knee with combined ACL deficiency and subtotal medial meniscectomy under anterior tibial and simulated quadriceps loads.

Methods

Eight human cadaveric knees were sequentially tested using a robotic testing system under 4 conditions: intact, ACL deficiency, ACL deficiency with subtotal medial meniscectomy, and single-bundle ACL reconstruction using a bone–patellar tendon–bone graft. Knee kinematics were measured at 0°, 15°, 30°, 60°, and 90° of flexion under an anterior tibial load of 130 N and a quadriceps muscle load of 400 N.

Results

Subtotal medial meniscectomy in the ACL-deficient knee significantly increased anterior and lateral tibial translations under the anterior tibial and quadriceps loads (P < .05). These kinematic changes were larger at high flexion (≥60°) than at low flexion angles. ACL reconstruction in knees with ACL deficiency and subtotal medial meniscectomy significantly reduced the increased anterior tibial translation, but could not restore anterior translation to the intact level with differences ranging from 2.6 mm at 0° to 5.5 mm at 30° of flexion. ACL reconstruction did not significantly affect the medial–lateral translation and internal–external tibial rotation in the presence of subtotal meniscectomy.

Conclusions

Subtotal medial meniscectomy in knees with ACL deficiency altered knee kinematics, especially at high flexion angles. ACL reconstruction significantly reduced the increased tibial translation in knees with combined ACL deficiency and subtotal medial meniscectomy, but could not restore the knee kinematics to the intact knee level.

Clinical Relevance

This study suggests that meniscus is an important secondary stabilizer against anterior and lateral tibial translations and should be preserved in the setting of ACL reconstruction for restoration of optimal knee kinematics and function.

Section snippets

Methods

Eight fresh-frozen cadaveric human knee specimens from 6 male and 2 female donors with an average age of 60 years (ranges, 59 to 64 years) were used in this study. The specimens had been stored at –20°C before the testing and had been thawed at room temperature for 24 hours before the experiment was conducted. Each specimen was examined for osteoarthritis and ACL injury using fluoroscopy and the manual stability test. Specimens with either of these conditions were not used in this study. The

Effect of ACL Deficiency on the Kinematics in the Meniscus-Intact Knees

The anterior tibial translation under the anterior tibial load in ACL-deficient knees was significantly larger than in the intact knee at all selected flexion angles (P < .05). The anterior tibial translation of the ACL-deficient knee increased until 30° of flexion and decreased thereafter (Table 1 and Fig 2). Under the muscle load, anterior tibial translation in the ACL-deficient knee was larger than in the intact knee at 0° to 30° of flexion (P < .05; Fig 3).

Effect of Subtotal Medial Meniscectomy on the Kinematics in ACL-Deficient Knees

Subtotal medial meniscectomy in

Discussion

This biomechanical study showed that subtotal medial meniscectomy in ACL-deficient knees increased anterior translation and lateral shift of the tibia. The effect of subtotal medial meniscectomy was larger at higher flexion angles than at lower flexion angles. ACL reconstruction using a BPTB graft significantly reduced anterior tibial translation at all flexion angles in knees with combined ACL deficiency and subtotal medial meniscectomy. However, ACL reconstruction alone was not able to

Conclusions

Subtotal medial meniscectomy in knees with ACL deficiency altered knee kinematics, especially at high flexion angles. ACL reconstruction significantly reduced the increased tibial translation in knees with combined ACL deficiency and subtotal medial meniscectomy, but could not restore the knee kinematics to the intact knee level.

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    Supported by Grant No. R01-AR055612 from the National Institutes of Health. The authors report no conflict of interest.

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