Impact of Medial Meniscotibial Ligament Disruption Compared to Peripheral Medial Meniscal Tear on Knee Biomechanics

2020 ◽  
Author(s):  
Patrick A. Smith ◽  
Joseph L. Humpherys ◽  
James P. Stannard ◽  
James L. Cook
Keyword(s):  
External Rotation ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Biomechanical Testing ◽  
Knee Biomechanics ◽  
Open Approach ◽  
Knee Stability ◽  
Anterior Laxity ◽  
Meniscotibial Ligament ◽  
Acl Deficient

AbstractMedial meniscotibial ligament (MTL) lesions may go unrecognized and untreated and have detrimental impact on knee biomechanics and joint pathology. Therefore, this study was designed to compare the biomechanical impact of midbody MTL disruption to corresponding peripheral medial meniscal (PMM) tears in anterior cruciate ligament (ACL) intact and ACL-deficient cadaveric knees. Cadaveric knees (n = 12; 6 matched pairs) were tested for laxity and ACL strain under anterior, valgus, and external rotation loading at 0, 30, and 90 degree of flexion. Knees were randomly assigned to ACL-intact (n = 6) or ACL-deficient (n = 6) groups. Large midbody MTL disruption or corresponding PMM tears were created (n = 3/group) and knees retested. PMM tears were repaired arthroscopically with inside-out suturing, and MTL lesions were repaired with suture anchors via an open approach. Knees were retested after repair. Biomechanical testing data were compared for statistically significant differences. Large MTL and PMM lesions were associated with significant increases in ACL strain, anterior laxity at 0, 30, and 90 degrees (p = 0.006), valgus laxity (p = 0.0012), and external rotation laxity (p = 0.0003) compared with intact knees. Repair of each lesion restored knee stability and reduced ACL strain to intact levels. In ACL-deficient knees, there was significantly increased anterior, valgus, and external rotation laxity compared with the ACL-intact state and MTL and PMM lesions further increased laxity at all angles. However, differences were not statistically significant and repair of meniscal lesions alone did not restore stability to ACL-deficient knees. These results highlight the need to recognize medial MTL injury and perform an appropriate repair procedure to restore knee stability and protect against excessive ACL strain.

The Effect of Hamstring Tendon Autograft Harvest on the Restoration of Knee Stability in the Setting of Concurrent Anterior Cruciate Ligament and Medial Collateral Ligament Injuries

2017 ◽  
Vol 46 (1) ◽  
pp. 163-170 ◽  
Author(s):  
Thomas J. Kremen ◽  
Landon S. Polakof ◽  
Sean S. Rajaee ◽  
Trevor J. Nelson ◽  
Melodie F. Metzger
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Knee Stability ◽  
Hamstring Autograft ◽  
Collateral Ligament ◽  
Intact State ◽  
Anterior Cruciate ◽  
Acl Deficient

Background: A hamstring autograft is commonly used in anterior cruciate ligament (ACL) reconstruction (ACLR); however, there is evidence to suggest that the tendons harvested may contribute to medial knee instability. Hypothesis: We tested the hypothesis that the gracilis (G) and semitendinosus (ST) tendons significantly contribute to sagittal, coronal, and/or rotational knee stability in the setting of ACLR with a concurrent partial medial collateral ligament (MCL) injury. Study Design: Controlled laboratory study. Methods: Twelve human cadaveric knees were subject to static forces applied to the tibia including an anterior-directed force as well as varus, valgus, and internal and external rotation moments to quantify laxity at 0°, 30°, 60°, and 90° of flexion. The following ligament conditions were tested on each specimen: (1) ACL intact/MCL intact, (2) ACL deficient/MCL intact, (3) ACL deficient/partial MCL injury, and (4) ACLR/partial MCL injury. To quantify the effect of muscle loads, the quadriceps, semimembranosus, biceps femoris, sartorius (SR), ST, and G muscles were subjected to static loads. The loads on the G, ST, and SR could be added or removed during various test conditions. For each ligament condition, the responses to loading and unloading the G/ST and SR were determined. Three-dimensional positional data of the tibia relative to the femur were recorded to determine tibiofemoral rotations and translations. Results: ACLR restored anterior stability regardless of whether static muscle loads were applied. There was no significant increase in valgus motion after ACL transection. However, when a partial MCL tear was added to the ACL injury, there was a 30% increase in valgus rotation ( P < .05). ACLR restored valgus stability toward that of the intact state when the G/ST muscles were loaded. A load on the SR muscle without a load on the G/ST muscles restored 19% of valgus rotation; however, it was still significantly less stable than the intact state. Conclusion: After ACLR in knees with a concurrent partial MCL injury, the absence of loading on the G/ST did not significantly alter anterior stability. Simulated G/ST harvest did lead to increased valgus motion. These results may have important clinical implications and warrant further investigation to better outline the role of the medial hamstrings, particularly among patients with a concomitant ACL and MCL injury. Clinical Relevance: A concurrent ACL and MCL injury is a commonly encountered clinical problem. Knowledge regarding the implications of hamstring autograft harvest techniques on joint kinematics may help guide management decisions.

scholarly journals Nonsurgical Management of an Anterior Cruciate Ligament-Deficient Knee in a Women's Soccer Player: A Validation Clinical Case Report

2017 ◽  
Vol 52 (11) ◽  
pp. 1079-1083
Author(s):  
Courtney E. Gray ◽  
Chris Hummel ◽  
Todd Lazenby
Keyword(s):  
Randomized Controlled Trial ◽  
Anterior Cruciate Ligament ◽  
Case Report ◽  
Soccer Player ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Randomized Controlled ◽  
Anterior Cruciate ◽  
Acl Deficient

Background:  A collegiate women's soccer player sustained an isolated anterior cruciate ligament (ACL) tear and expressed a desire to continue her season without surgical intervention. Design:  Case report. Intervention(s):  Using the results of a randomized controlled trial and published clinical guidelines, the clinicians classified the patient as an ACL-deficient coper. The patient completed her soccer season without incident, consistent with the findings of the established clinical guidelines. However, 6 months later, she sustained a meniscal tear, which was not unexpected given that 22% of ACL-deficient copers in the randomized controlled trial incurred a meniscal tear within 24 months of ACL injury. Conclusion:  The external evidence was helpful in making informed clinical decisions regarding patient care.

Time from Injury Is the Key Predictor of Meniscal Injury in ACL-Deficient Knees

2021 ◽  
Author(s):  
Seyed Mohammad Javad Mortazavi ◽  
Alireza Moharrami ◽  
S. S. Tamhri ◽  
Ali Okati ◽  
Ahmad Shamabadi
Keyword(s):  
Cruciate Ligament ◽  
Demographic Data ◽  
Meniscal Tear ◽  
Acl Injury ◽  
Meniscal Injury ◽  
Pain Visual Analog Scale ◽  
Initial Injury ◽  
Anterior Cruciate ◽  
And Gender ◽  
Acl Deficient

AbstractThe meniscus is one of the most important structures of the knee that needs to be saved if possible. Previous studies showed that increasing time from an anterior cruciate ligament (ACL) injury (TFI) could lead to a meniscal tear, especially medial meniscus (MM). We developed the present study to see if the TFI alone is a predictor of meniscal injury in ACL-deficient knees. We included 111 patients who had a reconstructed ACL injury at our institution from March 2015 to March 2016 in this retrospective cohort study. All demographic data, including age, gender, and body mass index (BMI), were collected. We also recorded the mechanism of injury and the TFI. We extracted the meniscal condition at the time of surgery from the surgical report. All patients were followed up for a mean of 23 months, and the Lysholm score and pain visual analog scale (VAS) score were obtained. The mean TFI of patients with MM tear was 17.4 ± 16.8 months, which was significant than the patients with lateral meniscal (LM) tear (9.3 ± 8.3 months) and intact meniscus (7.4 ± 8.1 months) (p = 0.001). Patients with TFI less than 6 months had a significantly lower rate of MM tear, and increasing TFI more than 6 months could increase the rate of MM tear (p = 0.001). We could not find any association between age, BMI, and gender and meniscal injury. At the latest follow-up, Lysholm and VAS scores in patients with and without meniscal tear were the same. Our study confirms that increasing time from the ACL injury would increase the risk of MM damage. The cutoff point for this risk factor is 6 months from initial injury; therefore, to save the meniscus, it might be better to perform ACL reconstruction within 6 months in ACL-deficient knees.

Correlation of Meniscal Tear with Timing of Anterior Cruciate Ligament Reconstruction in Patients without Initially Concurrent Meniscal Tear

2018 ◽  
Vol 32 (11) ◽  
pp. 1128-1132
Author(s):  
Kun-Hui Chen ◽  
En-Rung Chiang ◽  
Hsin-Yi Wang ◽  
Hsiao-Li Ma
Keyword(s):  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Acl Injury ◽  
Meniscus Tear ◽  
Meniscal Tears ◽  
Anterior Cruciate ◽  
Late Group ◽  
Acl Deficient

AbstractThe incidence of meniscal tear was reported to increase with the delay of anterior cruciate ligament reconstruction (ACLR). The tear may occur concurrently with the ACL injury or after the ACL injury. Few studies had focused on the patients whose meniscus is intact during ACL injury. We determined the correlation between timing of surgery and incidence of meniscal tears in ACL-deficient knees with initially intact meniscus. We retrospectively reviewed 387 patients who had undergone primary ACLR. Time of initial ACL injury, magnetic resonance imaging (MRI) examination, and surgery was recorded. The MRI was reviewed by experienced radiologic and orthopaedic doctors. Intraoperative arthroscopic images were also obtained and reviewed. The type of tear noted during surgery was classified according to the modification of International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine classification of meniscal tears. Patients were divided into early (surgery within 12 months from injury) and late surgery group (surgery at more than 12 months from injury). There were 216 patients with intact medial meniscus and 257 patients with intact lateral meniscus on the postinjury MRI study. The incidence of medial meniscus tear (MMT) was significantly higher than lateral meniscus tear (LMT) during the ACLR (33.8 vs. 19.8%, p < 0.001). The incidence of MMT is higher in late group than in early group (53.7 vs. 29.1%, p = 0.004, odds ratio= 2.815). The incidence of LMT is mildly higher in late group but without statistics significance (23.8 vs. 18.6%, p = 0.364). In both MMT and LMT, the most common injury pattern observed was a longitudinal tear. The incidence of each type is not different between early and late group. For patients without concurrent meniscal injuries with the ACL tear, the incidence of MMT significantly increased if ACLR was performed more than 12 months after injury. The medial meniscus was more prone to injury than the lateral meniscus in chronic ACL-deficient knee. ACLR should be performed earlier to reduce the risk of meniscal tears for patients without initially concurrent meniscal tear.

scholarly journals Rationale and Surgical Technique of Ramp Lesion Repair Through an Additional Posteromedial Portal

2021 ◽  
Vol 1 (1) ◽  
pp. 263502542199459
Author(s):  
Mathieu Thaunat ◽  
Jean-Marie Fayard ◽  
Benjamin Freychet ◽  
Thais Dutra Vieira ◽  
Bertrand Sonnery-Cottet
Keyword(s):  
External Rotation ◽  
Cruciate Ligament ◽  
Meniscal Repair ◽  
Visual Control ◽  
Anterior Tibial Translation ◽  
Anterior Portion ◽  
Repair Technique ◽  
Ramp Lesion ◽  
Tibial Translation ◽  
Meniscotibial Ligament

Background: Ramp lesions are longitudinal lesions of the meniscocapsular complex of the posterior horn of the medial meniscus. These lesions are poorly recognized, difficult to diagnose, and require specific arthroscopic exploration. Ramp lesions are typically associated with anterior cruciate ligament rupture and have important biomechanical consequences as they result in increased anterior tibial translation and external rotation. Suture hook repair through the posteromedial portal is safe and provides a high healing rate. Indications: Spontaneous healing of ramp lesions is rarely observed, and repair is indicated for all lesions with the involvement of meniscotibial ligament. The choice of a posteromedial repair technique with vertical suture performed under visual control allows restoration of the continuity of meniscotibial ligament and effective healing of these lesions. Technique Description: Standardized arthroscopic exploration with systematic visualization of the posteromedial compartment using the transnotch technique is a crucial point to diagnose these lesions. The use of transillumination and a needle allows to palpate the lesion with the tip of the needle in case of doubt (hidden lesion) before performing the posteromedial portal safely. By using the transnotch vision and by introducing the instruments through the posteromedial portal, debridement with the shaver and repair with the hook of the lesion are performed under visual control. Vertical repair is performed by taking care to pass the hook through the meniscotibial ligament by perforating the deep face of the capsular portion and anterior portion of the ramp lesion. Similarly, it is recommended not to catch too much meniscal tissue on the anterior margin side to remain in the red zone and not to perforate the meniscus in the avascular zone to avoid secondary lesions caused by the “cheese wire” effect of the sutures in the white zone. Results: This technique has allowed us to reduce our percentage of secondary meniscectomy after ramp lesion repair from 25% using a standard arthroscopic exploration and meniscal repair technique through the anterior portal to 11.3% using a arthroscopic exploration and repair technique through the posteromedial portal at 4 years of follow-up. Discussion/Conclusion: Systematic use of the transnotch vision and repair through the posteromedial portal are recommended for the management of these lesions, which demonstrate serious mechanical and clinical consequences.

scholarly journals A novel technique of treating anterior cruciate ligament injury: combining the ACL reconstruction and repair.

2020 ◽  
Author(s):  
Yuan Yang ◽  
Kang Chen ◽  
Wenzhe Feng ◽  
Weimin Zhu ◽  
Yuxiao Lai
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Anterior Cruciate Ligament Injury ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Ligament Injury ◽  
Knee Biomechanics ◽  
Knee Stability ◽  
Novel Technique ◽  
Anterior Cruciate

Abstract Background To illustrate a novel technique of treating anterior cruciate ligament injury. Methods If the ACL stump is strong enough and of good quality, we combine the ACL reconstruction and repair together. Results It is assumed that this will be better for the knee biomechanics in contrast to the simple reconstruction. This technique may also save the graft. That means we can only harvest one tendon gracilis or semitendinosus to satisfy the need of the knee stability. Conclusions This technique of combining the reconstruction and repair protects the knee proprioceptive feelings, accelerate the revascularization and strengthen the reconstructed ACL. This technique may also save the ligament graft and avoid the complications of the donor site. We are looking forward to comparing the outcomes of this technique to the outcomes of simple ACL reconstruction.

scholarly journals A Definition of Significant Instability and a Scoring System for Predicting Meniscal Tears in ACL-Deficient Knees

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986673 ◽  
Author(s):  
Amit Joshi ◽  
Nagmani Singh ◽  
Ishor Pradhan ◽  
Bibek Basukala ◽  
Ashok Kumar Banskota
Keyword(s):  
Acl Reconstruction ◽  
Scoring System ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Group Versus ◽  
Injury Rate ◽  
Meniscal Tears ◽  
Acl Tear ◽  
Medial Meniscal Tear ◽  
Acl Deficient

Background: Patients with anterior cruciate ligament (ACL)–deficient knees risk recurrent instability of the affected knee, which may predispose to meniscal injuries. Various studies have correlated the incidence of meniscal tear with elapsed time from ACL tear and number of instability events. However, it is not clear how significant an instability event needs to be to contribute to a meniscal tear. Purpose/Hypothesis: The purpose of this study was to (1) define a significant instability episode and (2) develop a checklist and scoring system for predicting meniscal tears based on significant instability episode. We hypothesized that patients with ACL-deficient knees who met the scoring threshold for a significant instability episode would have a higher incidence of meniscal tears compared with those who did not meet the threshold. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: This retrospective study included patients with magnetic resonance imaging (MRI)–confirmed isolated ACL tear for longer than 3 months. We determined parameters for assessing instability episodes and defined any instability events between the MRI and ACL reconstruction as significant or insignificant. Patients were then grouped into a significant instability group (≥1 significant episode) and an insignificant instability group, and the incidence and types of meniscal tears found during surgery were compared between groups. Results: There were 108 study patients: 62 in the significant instability group and 46 in the insignificant instability group. During surgery, 58 meniscal tears (46 medial, 12 lateral) were recorded, for an overall meniscal injury rate of 53.70%. In the significant instability group, 47 patients (75.81%) had a meniscal tear and 15 (24.19%) had intact menisci ( P < .001). In the insignificant instability group, 11 patients (23.91%) had a meniscal tear and 35 (76.08%) had intact menisci ( P < .001). Regarding the 58 patients with a meniscal tear, 47 (81.03%) had ≥1 significant episode of instability before surgery, as compared with 11 (18.97%) who had insignificant or no instability. The odds of having a medial meniscal tear at ACL reconstruction was 10 times higher in the significant instability group versus the insignificant instability group. Conclusion: The incidence of a medial meniscal tear was 10 times greater in patients with a significant episode of instability versus those with insignificant instability, as defined using a predictive scoring system. The incidence of lateral meniscal tear did not change with instability episodes.

Coupled Motions Under Compressive Load in Intact and ACL-Deficient Knees: A Cadaveric Study

2007 ◽  
Vol 129 (6) ◽  
pp. 818-824 ◽  
Author(s):  
David Liu-Barba ◽  
M. L. Hull ◽  
S. M. Howell
Keyword(s):  
Degrees Of Freedom ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Compressive Loading ◽  
Compressive Load ◽  
Axial Rotation ◽  
Anterior Translation ◽  
Acl Deficient ◽  
Deficient Knee ◽  
Intact Knee

Knowledge of the coupled motions, which develop under compressive loading of the knee, is useful to determine which degrees of freedom should be included in the study of tibiofemoral contact and also to understand the role of the anterior cruciate ligament (ACL) in coupled motions. The objectives of this study were to measure the coupled motions of the intact knee and ACL-deficient knee under compression and to compare the coupled motions of the ACL-deficient knee with those of the intact knee. Ten intact cadaveric knees were tested by applying a 1600N compressive load and measuring coupled internal-external and varus-valgus rotations and anterior-posterior and medial-lateral translations at 0deg, 15deg, and 30deg of flexion. Compressive loads were applied along the functional axis of axial rotation, which coincides approximately with the mechanical axis of the tibia. The ACL was excised and the knees were tested again. In the intact knee, the peak coupled motions were 3.8deg internal rotation at 0deg flexion changing to −4.9deg external rotation at 30deg of flexion, 1.4deg of varus rotation at 0deg flexion changing to −1.9deg valgus rotation at 30deg of flexion, 1.4mm of medial translation at 0deg flexion increasing to 2.3mm at 30deg of flexion, and 5.3mm of anterior translation at 0deg flexion increasing to 10.2mm at 30deg of flexion. All changes in the peak coupled motions from 0degto30deg flexion were statistically significant (p<0.05). In ACL-deficient knees, there was a strong trend (marginally not significant, p=0.07) toward greater anterior translation (12.7mm) than that in intact knees (8.0mm), whereas coupled motions in the other degrees of freedom were comparable. Because the coupled motions in all four degrees of freedom in the intact knee and ACL-deficient knee are sufficiently large to substantially affect the tibiofemoral contact area, all degrees of freedom should be included when either developing mathematical models or designing mechanical testing equipment for study of tibiofemoral contact. The increase in coupled anterior translation in ACL-deficient knees indicates the important role played by the ACL in constraining anterior translation during compressive loading.

Early Operative Versus Delayed Operative Versus Nonoperative Treatment of Pediatric and Adolescent Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652199081
Author(s):  
Evan W. James ◽  
Brody J. Dawkins ◽  
Jonathan M. Schachne ◽  
Theodore J. Ganley ◽  
Mininder S. Kocher ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Nonoperative Management ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Meniscal Tear ◽  
Nonoperative Treatment ◽  
Knee Stability ◽  
Meniscal Tears ◽  
Acl Injuries ◽  
Anterior Cruciate

Background: Treatment options for pediatric and adolescent anterior cruciate ligament (ACL) injuries include early operative, delayed operative, and nonoperative management. Currently, there is a lack of consensus regarding the optimal treatment for these injuries. Purpose/Hypothesis: The purpose was to determine the optimal treatment strategy for ACL injuries in pediatric and adolescent patients. We hypothesized that (1) early ACL reconstruction results in fewer meniscal tears than delayed reconstruction but yields no difference in knee stability and (2) when compared with nonoperative management, any operative management results in fewer meniscal tears and cartilage injuries, greater knee stability, and higher return-to-sport rates. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic search of databases was performed including PubMed, Embase, and Cochrane Library using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were a pediatric and adolescent patient population (≤19 years old at surgery), the reporting of clinical outcomes after treatment of primary ACL injury, and original scientific research article. Exclusion criteria were revision ACL reconstruction, tibial spine avulsion fracture, case report or small case series (<5 patients), non–English language manuscripts, multiligamentous injuries, and nonclinical studies. Results: A total of 30 studies containing 50 cohorts and representing 1176 patients met our criteria. With respect to nonoperative treatment, knee instability was observed in 20% to 100%, and return to preinjury level of sports ranged from 6% to 50% at final follow-up. Regarding operative treatment, meta-analysis results favored early ACL reconstruction over delayed reconstruction (>12 weeks) for the presence of any meniscal tear (odds ratio, 0.23; P = .006) and irreparable meniscal tear (odds ratio, 0.31; P = .001). Comparison of any side-to-side differences in KT-1000 arthrometer testing did not favor early or delayed ACL reconstruction in either continuous mean differences ( P = .413) or proportion with difference ≥3 mm ( P = .181). Return to preinjury level of competition rates for early and delayed ACL reconstruction ranged from 57% to 100%. Conclusion: Delaying ACL reconstruction in pediatric or adolescent patients for >12 weeks significantly increased the risk of meniscal injuries and irreparable meniscal tears; however, early and delayed operative treatment achieved satisfactory knee stability. Nonoperative management resulted in high rates of residual knee instability, increased risk of meniscal tears, and comparatively low rates of return to sports.

scholarly journals Using the Remnant Anterior Cruciate Ligament to Improve Knee Stability: Biomechanical Analysis Using a Cadaveric Model

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199648
Author(s):  
Derek T. Nhan ◽  
Stephen M. Belkoff ◽  
Prerna Singh ◽  
Brian T. Sullivan ◽  
Walter Klyce ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Stability ◽  
Native State ◽  
Rotational Laxity ◽  
Partial Tear ◽  
Acl Tear ◽  
Anterior Cruciate ◽  
Acl Deficient ◽  
Cadaveric Model

Background: Injured anterior cruciate ligament (ACL) tissue retains proprioceptive nerve fibers, vascularity, and biomechanical properties. For these reasons, remnant ACL tissue is often preserved during the treatment of ACL injuries. Purpose: To assess through a cadaveric model whether reorienting and retensioning the residual ACL via an osteotomy improves knee stability after partial ACL tear, with substantial remnant tissue and intact femoral and tibial attachments. Study Design: Controlled laboratory study. Methods: In 8 adult cadaveric knees, we measured anterior tibial translation and rotational laxity at 30° and 90° of flexion with the ACL in its native state and in 3 conditions: partial tear, retensioned, and ACL-deficient. The partial-tear state consisted of a sectioned anteromedial ACL bundle. Results: In the native state, the translation was 10 ± 2.7 mm (mean ± SD) at 30° of flexion and 8.4 ± 3.6 mm at 90° of flexion. Anterior translation of the knees in the partial-tear state (14 ± 2.7 mm at 30° and 12 ± 2.7 mm at 90°) was significantly greater than baseline ( P < .001 for both). Translation in the ACL-retensioned state (9.2 ± 1.7 mm at 30° and 7.2 ± 2.1 mm at 90°) was significantly less than in the ACL-deficient state ( P < .001 for both), and translation was not significantly different from that of the intact state. For ACL-deficient knees, translation (20 ± 4.3 mm at 30° and 16 ± 4.4 mm at 90°) was significantly greater than all other states ( P < .001 for all). Although rotational testing demonstrated the least laxity at 30° and 90° of flexion in the retensioned and intact states and the most laxity in the ACL-deficient state, rotation was not significantly different among any of the experimental states. Conclusion: In a cadaveric model of an incomplete ACL tear, a reorienting and retensioning core osteotomy at the tibial insertion of the remnant ACL improved anteroposterior translation of the knee without compromising its rotational laxity. Clinical Relevance: The findings of this study support the concept of ACL tissue reorienting and retensioning in the treatment of ACL laxity as an area for future investigation.

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