scholarly journals Isolated Meniscotibial Ligament Rupture: The Medial Meniscus “Belt Lesion”

2022 ◽  
Author(s):  
Sylvain Guy ◽  
Alexandre Ferreira ◽  
Alessandro Carrozzo ◽  
Jean-Romain Delaloye ◽  
Etienne Cavaignac ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Ligament Rupture ◽  
Meniscotibial Ligament

What Is the Relationship Between the Distal Semimembranosus Tendon and the Medial Meniscus? A Gross and Microscopic Analysis From the SANTI Study Group

2020 ◽  
pp. 036354652098007
Author(s):  
Etienne Cavaignac ◽  
Rémi Sylvie ◽  
Maxime Teulières ◽  
Andrea Fernandez ◽  
Karl-Heinz Frosch ◽  
...  
Keyword(s):  
Laboratory Study ◽  
Tibial Plateau ◽  
Medial Meniscus ◽  
Sagittal Plane ◽  
Microscopic Analysis ◽  
Joint Capsule ◽  
Posterior Horn ◽  
Ligament Injury ◽  
Semimembranosus Tendon ◽  
Meniscotibial Ligament

Background: Some authors have suggested that the semimembranosus tendon is involved in the pathophysiology of ramp lesions. This led us to conduct a gross and microscopic analysis of the posterior horn of the medial meniscus and the structures inserted on it. Hypothesis: (1) The semimembranosus tendon has a tendinous branch inserting into the posterior horn of the medial meniscus, and (2) the meniscotibial ligament is inserted on the posteroinferior edge of the medial meniscus. Study Design: Descriptive laboratory study. Methods: In total, 14 fresh cadaveric knees were dissected. From each cadaveric donor, a stable anatomic specimen was harvested en bloc, including the medial femoral condyle, medial tibial plateau, whole medial meniscus, cruciate ligaments, joint capsule, and distal insertion of the semimembranosus tendon. The harvested blocks were cut along the sagittal plane to isolate the distal insertion of the semimembranosus tendon on the posterior joint capsule and the posterior horn of the medial meniscus in a single slice. Histological slides were made from these samples and analyzed under a microscope. Results: In all knees, gross examination revealed a direct branch of the semimembranosus and a tendinous capsular branch ending behind the posterior horn of the medial meniscus. This capsular branch protruded over the joint capsule, over the meniscotibial ligament below and the meniscocapsular ligament above, but never ended directly in the meniscal tissue. The capsular branch was 14.3 ± 4.4 mm long (mean ± SD). The direct tendon inserted 11 ± 2.8 mm below the articular surface of the tibial plateau. The meniscotibial ligament inserted on the posteroinferior edge of the medial meniscus, and the meniscocapsular ligament insertion was on its posterosuperior edge. Highly vascularized adipose tissue was found, delimited by the posterior horn of the medial meniscus, meniscotibial ligament, meniscocapsular ligament, and capsular branch of the semimembranosus tendon. Conclusion: In all knees, our study found a capsular branch of the semimembranosus tendon inserted behind the medial meniscus. The meniscotibial ligament was inserted on the posteroinferior edge of the medial meniscus. Histological analysis of this area revealed that this ligament inserted differently from the insertion previously described in the literature. Clinical Relevance: This laboratory study provides insight into the pathophysiology of ramp lesions frequently associated with anterior cruciate ligament injury. To restore anatomy, it is mandatory to reestablish meniscotibial ligament continuity in ramp repairs.

scholarly journals The morphology and histology study on rabbit degenerated medial meniscus after posterior cruciate ligament rupture

2019 ◽  
Vol 39 (1) ◽  
Author(s):  
Zhenhan Deng ◽  
Wei Luo ◽  
Shanshan Gao ◽  
Zhan Liao ◽  
Yihe Hu ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Tissue Inhibitors Of Metalloproteinases ◽  
Histological Evaluation ◽  
Control Side ◽  
Ligament Rupture ◽  
Experimental Side ◽  
High Level ◽  
Posterior Cruciate Ligament Rupture

Abstract The morphology and histology changes in the medial meniscus after posterior cruciate ligament (PCL) rupture are poorly understood. Forty-eight rabbits were divided into matched mode pairs; each rabbit had an experimental side, in which the PCL was transacted, and a control side. At the 4, 8, 16 and 24 weeks after the PCL transection, each of the 12 rabbits was killed. Histology was performed to detect the expression of the tissue inhibitors of metalloproteinases-1 (TIMP-1), matrix metalloproteinase (MMP)-1 and MMP-13 in the medial meniscus. We found that medial meniscus displayed significant degenerative characteristics in morphology. The histological evaluation of the degeneration found that the expression levels of TIMP-1, MMP-1 and MMP-13 in the medial meniscus were higher in the experiment side than those in the control side (P<0.05). The expression of both TIMP-1 and MMP-13 was initially elevated and then decreased. The MMP-1 expression reached its peak swiftly and then maintained a relatively high level. There were clear time-dependent degenerative changes in the histology of the medial meniscus after PCL rupture. The high expression of TIMP-1, MMP-1 and MMP-13 in the cartilage may be responsible for the degeneration, and PCL rupture may trigger meniscus degradation and ultimately osteoarthritis.

scholarly journals Macroscopic and microscopic analysis of the structures inserted in the posterior segment of the medial meniscus. How is the semimembranosus tendon involved in ramp lesions?

2021 ◽  
Vol 9 (2_suppl) ◽  
pp. 2325967121S0001
Author(s):  
Etienne Cavaignac ◽  
Remy Sylvie ◽  
Maxime Teulières ◽  
Andrea Fernandez ◽  
Bertrand Sonnery-Cottet
Keyword(s):  
Medial Meniscus ◽  
Sagittal Plane ◽  
Microscopic Analysis ◽  
Joint Capsule ◽  
Posterior Segment ◽  
The Body ◽  
Semimembranosus Tendon ◽  
Tibial Condyle ◽  
Meniscotibial Ligament ◽  
Macroscopic Analysis

Objectives: The anatomical description of the posterior segment of the medial meniscus is debatable. The aim of this study was to describe by macroscopic and microscopic analysis the histological nature of the posterior segment of the medial meniscus and the inserted structures (semimembranosus tendon and menisco-tibial ligament) Methods: Fourteen fresh knees were dissected. For each specimen, a stable anatomical piece was taken en bloc, including the medial femoral condyle, the medial tibial condyle, the entire medial meniscus, the cruciate ligaments and the joint capsule, and the distal insertion of the semimembranosus tendon was preserved in its entirety. At this stage, a macroscopic analysis was performed. The blocks were cut along the sagittal plane in order to isolate the distal insertion of the semimembranosus tendon on the posterior joint capsule and the posterior segment of the medial meniscus in the same section. Histological slides were produced from these samples and were microscopically analyzed. Results: In all patients, the macroscopic analysis showed direct semimembranosus tendon expansion and tendinous capsular expansion ending behind the posterior segment of the medial meniscus. It projected onto the joint capsule, on the meniscotibial ligament at the bottom and the meniscocapsular ligament at the top, but never ended directly in the meniscal tissue. On average, the tendon directly inserted 11 ± 2.8 mm below the articular surface of the tibial plateau. The length of the capsular expansion was 14.3 ± 4.4 mm. The meniscotibial ligament was inserted in the posterior-inferior edge of the posterior segment of the medial meniscus and the meniscocapsular ligament in the posterior-superior edge. There was a particularly vascularized adipocyte space delimited by the posterior segment of the medial meniscus, the meniscotibial ligament, the meniscocapsular ligament and the capsular expansion of the semimembranosus tendon. Conclusion: We repeatedly noted capsular expansion of the semimembranosus tendon that inserted behind the medial meniscus. There is an interposing zone between the tendon insertion and the body of the meniscus which creates a fragile zone. The capsular tendon expansion also inserts in the meniscotibial ligaments at the bottom and meniscocapsular ligaments at the top.

scholarly journals Quantitative and Qualitative Assessment of the Posterior Medial Meniscus Anatomy: Defining Meniscal Ramp Lesions

2018 ◽  
Vol 47 (2) ◽  
pp. 372-378 ◽  
Author(s):  
Nicholas N. DePhillipo ◽  
Gilbert Moatshe ◽  
Jorge Chahla ◽  
Zach S. Aman ◽  
Hunter W. Storaci ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Qualitative Difference ◽  
Measuring System ◽  
Qualitative Assessment ◽  
Blue Staining ◽  
Alcian Blue Staining ◽  
Ramp Lesion ◽  
Fresh Frozen ◽  
Definition Of ◽  
Meniscotibial Ligament

Background: Meniscal ramp lesions have been defined as a tear of the peripheral attachment of the posterior horn of the medial meniscus (PHMM) at the meniscocapsular junction or an injury to the meniscotibial attachment. Precise anatomic descriptions of these structures are limited in the current literature. Purpose: To quantitatively and qualitatively describe the PHMM and posteromedial capsule anatomy pertaining to the location of a meniscal ramp lesion with reference to surgically relevant landmarks. Study Design: Descriptive laboratory study. Methods: Fourteen male nonpaired fresh-frozen cadavers were used. The locations of the posteromedial meniscocapsular and meniscotibial attachments were identified. Measurements to surgically relevant landmarks were performed with a coordinate measuring system. To further analyze the posteromedial meniscocapsular and meniscotibial attachments, hematoxylin and eosin and alcian blue staining were conducted on a separate sample of 10 nonpaired specimens. Results: The posterior meniscocapsular attachment had a mean ± SD length of 20.2 ± 6.0 mm and attached posteroinferiorly to the PHMM at a mean depth of 36.4% of the total posterior meniscal height. The posterior meniscotibial ligament attached on the PHMM 16.5 mm posterior and 7.7 mm medial to the center of the posterior medial meniscal root attachment. The meniscotibial ligament tibial attachment was 5.9 ± 1.3 mm inferior to the articular cartilage margin of the posterior medial tibial plateau. The posterior meniscocapsular attachment converged with the meniscotibial ligament at the most posterior point of the meniscocapsular junction in all specimens. Histological staining of the meniscocapsular and meniscotibial ligament PHMM attachments showed similar structure, cell density, and fiber directionality, with no qualitative difference in the makeup of their collagen matrices across all specimens. Conclusion: The anatomy of the area where a medial meniscal ramp tear occurs revealed that the 2 posterior meniscal attachments merged at a common attachment on the PHMM. Histological analysis validated a shared attachment point of the meniscocapsular and meniscotibial attachments of the PHMM. Clinical Relevance: The findings of this study provide the anatomic foundation for an improved understanding of the meniscocapsular and meniscotibial attachments of the PHMM, which may help provide a more precise definition of a meniscal ramp lesion.

scholarly journals Ultrasonographic Evaluation of Dogs with Cranial Cruciate Ligament Rupture Undergoing to Arthrotomy

2019 ◽  
Vol 47 (1) ◽  
Author(s):  
Luanna Ferreira Fasanelo Gomes ◽  
Thales Bregadioli ◽  
Stefano Carlo Filippo Hagen
Keyword(s):  
Magnetic Resonance Imaging ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Meniscal Tears ◽  
Resonance Imaging ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint ◽  
Ligament Rupture ◽  
Meniscus Tears ◽  
Cranial Cruciate Ligament Rupture

Background: The cranial cruciate ligament rupture (CrCLR) is the most common disease of the stifle joint in dogs. One of the major concerns in the assessment of these animals is diagnosing the presence of a medial meniscus tears, which is a frequent consequence due to the instability of the joint. Ultrasonography is indicated in the evaluation of the menisci from human and canine patients, and the results are similar to magnetic resonance imaging. The aim of this study was to compare the ultrasonography and the arthrotomy in the evaluation of the cranial cruciate ligament and medial meniscus of dogs with CrCLR undergoing surgery for stifle stabilization.Materials, Methods & Results: Ultrasonographic examination was performed prior to arthrotomy in 23 dogs with diagnosis of complete CrCLR and five with suspected partial CrCLR undergoing for stifle joint stabilization surgery. The ultrasonography identified the complete rupture in 82.6% and the arthrotomy in 100% of the joints with this diagnosis. In the joints with suspected CrCLR during the clinical exam, arthrotomy and ultrasonography identified respectively three and four joints with partial CrCLR, and two and one with healthy ligaments. There was no difference between the two techniques in the assessment of the cranial cruciate ligament (P = 0.20). The ultrasonography identified medial meniscal tears in 39.3%, while arthrotomy was found in 21.4% (P = 0.0006) of the joints. The most frequent meniscal tear type observed in the arthrotomy was folded caudal horn. The ultrasonography was able only in differentiate presence and absence of meniscal injury. Besides the real tear that affects the meniscus morphology, the ultrasound also identified echogenicity and echotexture changes in the medial (5/28) and lateral (8/28) menisci. Other changes observed in all joints evaluated by ultrasound were the presence of effusion and synovial membrane thickening.Discussion: The complete and almost complete CrCLR are diagnosed by clinical examination through the evaluation of instability of the stifle joint, which is not possible in partial CrCLR in stable joints. In this study of the five evaluated stable joints, the ultrasound correctly identified the partial CrCLR in three joints and the ligament integrity in one of the joints when compared to arthrotomy. In animals with stifle joint instability the meniscus assessment is fundamental as it is one of the main causes of persistent lameness in dogs subjected to conservative or surgical treatment. Ultrasonography cannot differentiate the types of meniscal tears but identified approximately 1.8 times more medial meniscus tears compared to arthrotomy. Despite the bucket handle being the most common tear of medial meniscus in dogs with CrCLR, four of the six meniscal tears identified by arthrotomy were folded caudal horn. This lesion causes cranial displacement of the caudal horn which may have facilitated its identification by minimally invasive arthrotomy, being the probable reason for its high incidence in this study. Echogenicity and echotexture changes without affecting the meniscus morphology were related with intrasubstance degeneration described in human medicine. Ultrasonography is not the better technique to assess the CrCL but can assist in identifying partial ruptures. Because it has results similar to magnetic resonance imaging, ultrasonography is an important tool in the diagnosis of meniscus tears.

Sign in / Sign up

Export Citation Format

Share Document