Posterior Medial Meniscus Root Tears Potentiate the Effect of Increased Tibial Slope on Anterior Cruciate Ligament Graft Forces

2019 ◽  
Vol 48 (2) ◽  
pp. 334-340 ◽  
Author(s):  
Brian T. Samuelsen ◽  
Zachary S. Aman ◽  
Mitchell Iung Kennedy ◽  
Grant J. Dornan ◽  
Hunter W. Storaci ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Medial Meniscus ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Tibial Osteotomy ◽  
Root Tear ◽  
Meniscus Root ◽  
Root Repair ◽  
Meniscus Root Tear

Background: Increased posterior tibial slope and posterior medial meniscus root tears increase the force experienced by the anterior cruciate ligament (ACL) and predispose patients to higher rates of primary ACL injury or ACL graft failure after an ACL reconstruction (ACLR). However, the interplay among sagittal plane tibial slope, medial meniscus root tears, and ACLR graft force remains inadequately defined. Purpose/Hypothesis: The purpose was to quantify the effect of sagittal plane tibial slope on ACLR graft force at varying knee flexion angles with an intact medial meniscus, a posterior medial meniscus root tear, and a medial meniscus root repair. Our null hypothesis was that changes in slope and meniscal state would have no effect on the forces experienced by the ACLR graft. Study Design: Controlled laboratory study. Methods: Ten male fresh-frozen cadaveric human knees underwent a posteriorly based high tibial osteotomy. A spanning external fixator and wedges of varying sizes were used to stabilize the osteotomy and allow for accurate slope adjustment. After ACLR, specimens were compressed with a 1000-N axial load at flexion angles of 0° and 30° for each of the 3 meniscal states and at tibial slopes of 0° to 15° at 3° increments. Graft loads were recorded through a force transducer clamped to the graft. Results: Increasing tibial slope led to a linear increase in ACLR graft force at 0° and 30° of knee flexion. Posterior medial meniscus root tear led to significant increases in ACLR graft forces over the intact state, while root repair restored the function of the medial meniscus as a secondary stabilizer. At 30° of knee flexion, the tibial slope effect on ACLR graft force was potentiated in the root tear state as compared with the intact and root repair states—test of interaction effect: t(139) = 2.67 ( P = .009). Conclusion: Increases in tibial slope lead to a linear increase in ACLR graft forces, and this effect is magnified in the setting of a posterior medial meniscus root tear. At slopes >12°, a slope-changing osteotomy could be considered in the setting of a revision ACLR with a concomitant medial meniscus root tear. Clinical Relevance: Defining the relationship between tibial slope and varying states of meniscal insufficiency can help determine when it may be necessary to perform a slope-decreasing proximal tibial osteotomy before ACLR and meniscal repair.

Magnetic Resonance Imaging Findings of Surgically Proven Medial Meniscus Root Tear

2008 ◽  
Vol 32 (3) ◽  
pp. 452-457 ◽  
Author(s):  
Yong Gu Lee ◽  
Jae-Chan Shim ◽  
Yun Sun Choi ◽  
Jin Goo Kim ◽  
Ghi Jai Lee ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Medial Meniscus ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Root Tear ◽  
Meniscus Root ◽  
Meniscus Root Tear

scholarly journals Meniscal Root Repair in Pediatric Patients: Minimum 2-Year Outcomes (196)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0030
Author(s):  
S. Clifton Willimon ◽  
Michael Busch ◽  
Asahi Murata ◽  
Crystal Perkins
Keyword(s):  
Patient Satisfaction ◽  
Pediatric Patients ◽  
Medial Meniscus ◽  
Lateral Meniscus ◽  
Injury Pattern ◽  
Posterior Root ◽  
Root Tear ◽  
Meniscus Root ◽  
Root Repair

Objectives: The medial and lateral menisci function to optimize force transmission across the knee by increasing contact area between the femur and tibia, absorbing shock, and transmitting loads. The anterior and posterior meniscus roots anchor the meniscus to bone. Injuries to the meniscus root attachments result in extrusion of the meniscus, impaired distribution of hoop stresses, and progressive degenerative articular wear. As a result of these deleterious effects, there has been increasing emphasis on repair of meniscus root injuries to restore structure and function. The purpose of this study is to describe meniscus root tears, associated injuries, and minimum 2-year treatment outcomes in a series of pediatric patients. Methods: A single-institution, IRB approved, retrospective review was performed of consecutive pediatric patients less than 19 years of age with a meniscus root tear treated with transosseous root repair over a 4-year period. All patients had minimum 24-month clinical follow-up. Partial root tears treated with partial meniscectomy or irreparable root tears were excluded. All meniscus root tears were classified arthroscopically based on the tear types described by LaPradeADDIN EN.CITE 9. The primary outcomes were revision meniscus surgery and patient reported outcome scores (PROs) (Lysholm, Patient Satisfaction, and Tegner activity). Results: Twenty-one patients, 11 males and 10 females with a mean age of 15 years (range 7 – 18 years), met inclusion criteria. There were 15 lateral meniscus root tears and 6 medial meniscus root tears. The tears occurred in the posterior root in 20 patients (95%). The most common injury pattern was a lateral meniscus posterior root tear (14 patients, 67%). 18 patients (86%) had an associated ligament tear: 13 ACL tears and 5 PCL tears. Two root tears occurred in isolation, and both were the posterior root of the medial meniscus. The majority of meniscus root tears (15 patients, 71%) were root avulsions (type 5). Mean follow-up was 42 months (range 25 – 71 months). Three patients had a second surgery on the affected knee. In two patients, one with revision ACL reconstruction and one treated with chondroplasty of the patella, the meniscus root repair was noted to be well healed. A third patient sustained a new injury to the knee 4 years following medial meniscus posterior root repair and underwent partial medial meniscectomy. At final follow-up, PROs were obtained for 17 patients (81%). Mean Lysholm score was 91 (range 51 – 100). Mean patient satisfaction score was 8.7 (range 5 – 10). Fourteen of 16 patients (88%) reported returning to the same or higher level of activity following surgery. Conclusions: Meniscus root tears occur in pediatric patients, most commonly as root avulsions of the posterior root of the lateral meniscus and in association with ACL tears. This is unique as compared to the adult population, in which the medial meniscus posterior root is often injured in isolation and radial tears adjacent the root are the most commonly described injury pattern. In our case series, transosseous root repair resulted in successful outcomes in the majority of patients with durable results at midterm follow-up.

Tibial Slope and Its Effect on Force in Anterior Cruciate Ligament Grafts: Anterior Cruciate Ligament Force Increases Linearly as Posterior Tibial Slope Increases

2019 ◽  
Vol 47 (2) ◽  
pp. 296-302 ◽  
Author(s):  
Andrew S. Bernhardson ◽  
Zachary S. Aman ◽  
Grant J. Dornan ◽  
Bryson R. Kemler ◽  
Hunter W. Storaci ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Linear Relationship ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Tibial Osteotomy ◽  
Acl Graft ◽  
Posterior Tibial ◽  
Axially Loaded ◽  
Anterior Cruciate

Background: Previous work has reported that increased tibial slope is directly correlated with increased anterior tibial translation, possibly predisposing patients to higher rates of anterior cruciate ligament (ACL) tears and causing higher rates of ACL graft failures over the long term. However, the effect of changes in sagittal plane tibial slope on ACL reconstruction (ACLR) graft force has not been well defined. Purpose/Hypothesis: The purpose of this study was to quantify the effect of changes in sagittal plane tibial slope on ACLR graft force at varying knee flexion angles. Our null hypothesis was that changing the sagittal plane tibial slope would not affect force on the ACL graft. Study Design: Controlled laboratory study. Methods: Ten male fresh-frozen cadaveric knees had a posterior tibial osteotomy performed and an external fixator placed for testing and accurate slope adjustment. Following ACLR, specimens were compressed with a 200-N axial load at flexion angles of 0°, 15°, 30°, 45°, and 60°, and the graft loads were recorded through a force transducer clamped to the graft. Tibial slope was varied between −2° and 20° of posterior slope at 2° increments under these test conditions. Results: ACL graft force in the loaded testing state increased linearly as slope increased. This effect was independent of flexion angle. The final model utilized a 2-factor linear mixed-effects regression model and noted a significant, highly positive, and linear relationship between tibial slope and ACL graft force in axially loaded knees at all flexion angles tested (slope coefficient = 0.92, SE = 0.08, P < .001). Significantly higher graft force was also observed at 0° of flexion as compared with all other flexion angles for the loaded condition (all P < .001). Conclusion: The authors found that tibial slope had a strong linear relationship to the amount of graft force experienced by an ACL graft in axially loaded knees. Thus, a flatter tibial slope had significantly less loading of ACL grafts, while steeper slopes increased ACL graft loading. Our biomechanical findings support recent clinical evidence of increased ACL graft failure with steeper tibial slope secondary to increased graft loading. Clinical Relevance: Evaluation of the effect of increasing tibial slope on ACL graft force can guide surgeons when deciding if a slope-decreasing proximal tibial osteotomy should be performed before a revision ACLR. Overall, as slope increases, ACL graft force increases, and in our study, flatter slopes had lower ACL graft forces and were protective of the ACLR graft.

scholarly journals Worsening of Radiographic Knee Osteoarthritis Following Medial Meniscus Root Tears and Non-Root Tears

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0025
Author(s):  
Caitlin C. Chambers ◽  
John A. Lynch ◽  
Brian T. Feeley ◽  
Michael C. Nevitt
Keyword(s):  
Knee Osteoarthritis ◽  
Knee Injury ◽  
Medial Meniscus ◽  
Meniscal Tear ◽  
Activity Level ◽  
Root Tear ◽  
Index Visit ◽  
Meniscus Root ◽  
History Of ◽  
Meniscus Root Tear

Objectives: Medial meniscus root tear has an established association with knee osteoarthritis (OA), but little is known about the time course of cartilage breakdown or the severity of cartilage damage when compared to meniscal tears which spare the root. The aims of this study were to compare early progressive radiographic degenerative changes in knees with medial meniscus root tears (RT) and medial meniscus tears sparing the root (non-root tears: NRT), and identify risk factors for osteoarthritic progression among patients with RT. Methods: A convenience sample of 3,121 knees from 2,656 participants was drawn from the NIH-funded multicenter Osteoarthritis Initiative (OAI) database. All knees with medial meniscus RT or NRT seen on initial baseline MRI (prevalent) or on subsequent visit MRI (incident) were included. Demographics including sex, age, body mass index (BMI), activity level, knee injury, and knee pain were recorded at index visit (visit at which meniscal injury was first seen) and compared between prevalent RT versus NRT and incident RT versus NRT groups. Radiographic OA worsening was defined as an increase in Kellgren-Lawrence Grade (KLG) at any time from the last normal MRI 12 months before meniscal tear diagnosis (T-12, available in incident tears only) to the index visit (T0), to follow-up MRI 12 months after meniscal tear diagnosis (T+12). Additionally, characteristics of RT patients with OA worsening were compared to those who did not have progressive degenerative changes. Continuous variables were compared using a student’s t-test. Categorical data were compared using Fisher’s exact and chi-squared tests. Results: Within the OAI database, 78 medial meniscus RTs (45 prevalent, 33 incident) were identified, along with 1,030 medial meniscus NRTs (775 prevalent, 255 incident). 75% of incident RTs and 40.9% of incident NRTs (p<0.0001) demonstrated radiographic OA worsening in the 24 months studied, most often concurrent with the medial meniscus root tear, progressing between the last pre-injury MRI (T-12) and the index visit (T0) (Figure 1). As compared to incident NRT, patients with incident RT were more often female, heavier, had a higher activity level, a history of knee injury, and a higher KLG (table 1). Prevalent RT and NRT groups were similar in demographics and rates of radiographic OA worsening. Demographics of patients with incident RT that underwent radiographic OA progression versus those which did not progress were similar with no significant difference in sex, age, BMI, activity level, or history of knee injury and frequent knee pain. The OA progression knees were significantly more likely to have KLG of 0 -1 on pre-RT radiographs than the group that did not progress (66.7% versus 12.5%, p=0.01). Conclusion: For participants with incident medial meniscus tear during the 4-years of OAI, RTs were associated with significantly more progression of radiographic OA than NRTs. A majority of individuals with RTs deny a severe knee injury in the twelve months preceding MRI diagnosis the tear. Compared to incident NRTs, incident RTs were significantly more likely to occur in overweight and more active women, in knees with more severe radiographic OA, and had substantially worse radiographic outcome. Knees which demonstrated radiographic OA progression after incident RT were more likely to have a normal baseline KLG than those which did not progress, but otherwise there were no significant demographic predictors of OA worsening following RT. [Table: see text][Figure: see text]

scholarly journals MENISCUS ROOT TEARS IN CHILDREN AND ADOLESCENTS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0003
Author(s):  
S. Clifton Willimon ◽  
Melissa Christino ◽  
Michael Busch ◽  
Crystal Perkins
Keyword(s):  
Pediatric Patients ◽  
Medial Meniscus ◽  
Lateral Meniscus ◽  
Posterior Root ◽  
Associated Injuries ◽  
Inclusion Criteria ◽  
Root Tear ◽  
Meniscus Root ◽  
Meniscus Root Tear

Background: The medial and lateral menisci function to optimize force transmission across the knee by increasing contact area between the femur and tibia, absorbing shock, and transmitting loads. Injuries to the meniscus root attachments result in extrusion of the meniscus, impaired distribution of hoop stresses, and degenerative articular wear. The purpose of this study is to describe meniscus root tears, associated injuries, and treatment in a series of pediatric patients Methods: A single-institution retrospective review was performed of consecutive pediatric patients treated for meniscus root tears from 2013 – 2017. Inclusion criteria were patients less than 19 years of age, arthroscopic evidence of a meniscus root tear, and minimum 6 months clinical follow-up. The primary outcome was surgery for revision of the meniscus repair. Results: Twenty-seven patients were identified to fit inclusion criteria. There were 15 males and 12 females with a mean age of 15.2 years (range 7 – 18 years). Basketball, soccer, and football accounted for the majority (56%) of injuries. The lateral meniscus was involved in 21 patients (78%) and the medial meniscus in 6 patients (22%). The posterior meniscus root was torn in 25 patients (93%) and anterior meniscus root in 2 patients (7%). The most common injury pattern was a lateral meniscus posterior root tear (19 patients, 70%). Associated injuries included an ACL tear (19 patients, 70%), PCL tear (6 patients, 22%), and a tear of the opposite meniscus (7 patients, 26%). Two root tears occurred in isolation, and both were of the posterior root of the medial meniscus. All patients were treated surgically with an arthroscopic transosseous root repair in addition to simultaneous treatment for their associated injuries. Mean follow-up was 14 months (range 6 – 37 months). No patients required additional surgery for their meniscus root tear. Two patients had a second surgery on the affected knee: one for revision ACL reconstruction 2 years following the primary procedure and the other for chondroplasty of the patella 2.5 years following the primary procedure. Conclusions: Meniscus root tears occur in pediatric and adolescent patients, most commonly affecting the posterior root of the lateral meniscus and occurring in association with ACL tears. The adolescent meniscus root injury pattern is unique compared to the adult population in which the medial meniscus posterior root is often injured in isolation. Inspection of the meniscus root attachments with deliberate probing to assess the meniscus roots should be a routine part of every knee arthroscopy. In our case series, transosseous root repair resulted in successful outcomes in all patients without need for any additional meniscus treatment.

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