Ultrasound diagnosis of injuries of the cranial meniscotibial ligament of the medial meniscus

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.

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Posterior horn instability of the medial meniscus a sign of posterior meniscotibial ligament insufficiency

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-011-1424-1 ◽

2011 ◽

Vol 19 (7) ◽

pp. 1148-1153 ◽

Cited By ~ 21

Author(s):

P. P. Mariani

Keyword(s):

Medial Meniscus ◽

Posterior Horn ◽

Meniscotibial Ligament

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Stifle extension results in differential tensile forces developing between abaxial and axial components of the cranial meniscotibial ligament of the equine medial meniscus: A mechanistic explanation for meniscal tear patterns

Equine Veterinary Journal ◽

10.1111/j.2042-3306.2011.00532.x ◽

2011 ◽

Vol 44 (5) ◽

pp. 554-558 ◽

Cited By ~ 12

Author(s):

J. G. FOWLIE ◽

S. P. ARNOCZKY ◽

M. LAVAGNINO ◽

J. A. STICK

Keyword(s):

Medial Meniscus ◽

Meniscal Tear ◽

Mechanistic Explanation ◽

Tensile Forces ◽

Meniscotibial Ligament

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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?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00015 ◽

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.

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

The American Journal of Sports Medicine ◽

10.1177/0363546518814258 ◽

2018 ◽

Vol 47 (2) ◽

pp. 372-378 ◽

Cited By ~ 22

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.

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

Arthroscopy Techniques ◽

10.1016/j.eats.2021.09.013 ◽

2022 ◽

Author(s):

Sylvain Guy ◽

Alexandre Ferreira ◽

Alessandro Carrozzo ◽

Jean-Romain Delaloye ◽

Etienne Cavaignac ◽

...

Keyword(s):

Medial Meniscus ◽

Ligament Rupture ◽

Meniscotibial Ligament

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Traumatic Injury of Medial Meniscotibial Ligament – Diagnostics and Conservative Treatment

Acta Balneologica ◽

10.36740/abal202001111 ◽

2020 ◽

Vol 62 (1) ◽

pp. 60-66

Author(s):

Kamil Zaworski ◽

Gustaw Wójcik ◽

Bartosz Rutowicz

Keyword(s):

Conservative Treatment ◽

Medial Collateral Ligament ◽

Medial Meniscus ◽

Cruciate Ligament ◽

Traumatic Injury ◽

Knee Injuries ◽

Proximal Part ◽

Diagnostic Methods ◽

Collateral Ligament ◽

Meniscotibial Ligament

The paper aims to present diagnostic methods and options of conservative treatment of traumatic injuries of medial meniscotibial ligament (MTL). Ca. 75% of all sport-related injuries pertains to the lower extremity; among those, knee damage the second most frequent, after ankle damage. The anteromedial part is where knee pain occurs most frequently. Knee injuries often lead to damage to ligament structures, including medial meniscotibial ligament, which is rarely reported in the literature. Those ligaments may be damaged when the knee is subject to forces leading to valgity and rotation of the femur, internally, and of the tibia, externally. Damage may be caused in an isolated manner, through overloads and combined microdamage. Medial meniscotibial ligaments are formed by a fibrous layer of the articular capsule and are a part of the deep medial collateral ligament. They run from the medial meniscus to the proximal part of the tibia. An MTL examination consists of three parts: medical interview, physical examination and additional examinations. Due to the structure of MTL, its diagnostics must be expanded by an examination of the anterior cruciate ligament (ACL), medial collateral ligament (MCL) and the medial meniscus. Treatment in the acute condition is carried out according to the PRICE (Protection, Rest, Ice, Compression, Elevation) rules. In the subacute and chronic condition, therapy may be expanded for instance by manual therapy methods, functional training, physical therapy and kinesiology taping.

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Apportionment of Impairment from Meniscal Tears and Knee Arthritis

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2013.sepoct01 ◽

2013 ◽

Vol 18 (5) ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Charles N. Brooks ◽

James B. Talmage

Keyword(s):

Medial Meniscus ◽

Degenerative Joint Disease ◽

Joint Disease ◽

Detailed Knowledge ◽

Meniscal Tears ◽

Knee Arthritis ◽

Degenerative Arthritis ◽

Study Results ◽

Physical Findings ◽

Causation Analysis

Abstract Meniscal tears and osteoarthritis (osteoarthrosis, degenerative arthritis, or degenerative joint disease) are two of the most common conditions involving the knee. This article includes definitions of apportionment and causes; presents a case report of initial and recurrent tears of the medial meniscus plus osteoarthritis (OA) in the medial compartment of the knee; and addresses questions regarding apportionment. The authors, experienced impairment raters who are knowledgeable regarding the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), show that, when instructions on impairment rating are incomplete, unclear, or inconsistent, interrater reliability diminishes (different physicians may derive different impairment estimates). Accurate apportionment of impairment is a demanding task that requires detailed knowledge of causation for the conditions in question; the mechanisms of injury or extent of exposures; prior and current symptoms, functional status, physical findings, and clinical study results; and use of the appropriate edition of the AMA Guides. Sometimes the available data are incomplete, requiring the rating physician to make assumptions. However, if those assumptions are reasonable and consistent with the medical literature and facts of the case, if the causation analysis is plausible, and if the examiner follows impairment rating instructions in the AMA Guides (or at least uses a rational and hence defensible method when instructions are suboptimal), the resulting apportionment should be credible.

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