Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleThe 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
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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Cited by (66)
Meniscal Tears, Posterolateral and Posteromedial Corner Injuries, Increased Coronal Plane, and Increased Sagittal Plane Tibial Slope All Influence Anterior Cruciate Ligament–Related Knee Kinematics and Increase Forces on the Native and Reconstructed Anterior Cruciate Ligament: A Systematic Review of Cadaveric Studies
2022, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :In addition, due to the extent of studies investigating the influence of anterolateral corner injury on ACL (graft) force and ACL-related knee kinematics this subject is systematically reviewed in a separate review. The MM was found to be an important secondary restraint to ATT, especially in ACL-deficient knees,25,27,29,30,32,33,35 in which the MMPH acts as a “bumper” to ATT and is therefore prone to injury due to recurrent trauma in ACL injured knees.35,30,33,35 The significant increase in strain or in situ force on the native ACL with anterior tibial loading after a total meniscectomy26,28 or longitudinal body tear34 further stresses the importance of preserving the MM when it is torn.
Steep posterior slope of the medial tibial plateau is associated with ramp lesions of the medial meniscus and a concomitant anterior cruciate ligament injury
2021, Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and TechnologyCitation Excerpt :Peripheral longitudinal tears of the MM are also commonly seen with acute ACL injuries.2 Because the posterior segment of the MM acts as a secondary stabiliser of anterior tibial translation (ATT)3,4 and the ACL is the main restriction to anterior tibial loads,5,6 it is reported that the repair of peripheral MM tears decreases the risk of post-operative knee pain and subsequent arthroscopic salvation in ACL-reconstructed knees.7,8 In a systematic review, ACL reconstruction (ACLR) combined with the meniscal repair was reported to result in decreased anterior knee joint laxity with evidence of improved patient-reported outcomes in the long term.9
Alteration in ACL loading after total and partial medial meniscectomy
2024, BMC Musculoskeletal Disorders
Supported by Grant No. R01-AR055612 from the National Institutes of Health. The authors report no conflict of interest.