Kinematic Analysis of Lateral Meniscal Oblique Radial Tears in the Anterior Cruciate Ligament–Deficient Knee

2021 ◽  
pp. 036354652110525
Author(s):  
Patrick A. Smith ◽  
Will A. Bezold ◽  
Cristi R. Cook ◽  
Aaron J. Krych ◽  
Michael J. Stuart ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Joint Stability ◽  
Meniscal Extrusion ◽  
Anterior Drawer ◽  
Anterior Translation ◽  
Meniscus Root ◽  
Acl Deficiency ◽  
Anterior Cruciate ◽  
Acl Deficient

Background: Lateral meniscal oblique radial tears (LMORT) occur frequently in conjunction with anterior cruciate ligament (ACL) disruption and are anatomically distinct from meniscus root tears. Hypothesis/Purpose: The purpose of this study was to characterize the effects of LMORT types 3 (LMORT3) and 4 (LMORT4) lesions on joint stability and meniscal extrusion in ACL-deficient knees. Our hypothesis was that both lesions would promote significant increases in anterior translation and meniscal extrusion, with the LMORT4 lesion having a greater effect. Study Design: Controlled laboratory study. Methods: Two matched pairs of cadaveric knees (n = 4) were used to optimize the testing sequence. Additional cadaveric knees with LMORT3 (n = 8) and LMORT4 (n = 8) lesions created after ACL transection underwent robotic kinematic testing for anterior drawer and pivot-shift simulations with associated ultrasound-measured meniscal extrusion at clinically relevant knee flexion angles. Results: Optimization testing showed no differences on the effect of LMORT4 lesions for anterior translation and lateral meniscal extrusion with ACL-intact versus ACL-deficient knees. ACL deficiency and LMORT3 and LMORT4 lesions with ACL deficiency were associated with significantly greater anterior translation compared with ACL-intact state for both anterior drawer and pivot-shift testing at all flexion angles ( P < .001). ACL deficiency with either LMORT3 or LMORT4 lesion was associated with significantly greater anterior translation than was ACL deficiency only ( P < .005) for anterior drawer testing at 90° of flexion. Meniscal extrusion was greater with LMORT3 and LMORT4 lesions compared with ACL deficiency only ( P < .05) for anterior drawer at 60° of flexion and for pivot shift at 15° of flexion. The LMORT4 lesion demonstrated increased anterior translation for anterior drawer ( P = .003) at 60° of flexion (12%) as well as for pivot shift at 15° of flexion (7%) and 30° of flexion (13%) ( P < .005) compared with ACL deficiency only. Conclusion: In this cadaveric model, the addition of an LMORT3 or LMORT4 lesion increased anterior laxity for both the anterior drawer and the pivot shift when compared with an isolated ACL tear. Lateral meniscal extrusion was also exacerbated by these LMORT lesions. Clinical Relevance: LMORT lesions, distinct from meniscus root tears, occur frequently in conjunction with ACL tears. This study characterized the biomechanical consequences of LMORT3 and LMORT4 lesions on joint stability and meniscal function, highlighting the importance of diagnosing and treating LMORT lesions at the time of ACL reconstruction.

scholarly journals Magnetic Tracking: A Novel Method of Assessing Anterior Cruciate Ligament Deficiency

2006 ◽  
Vol 88 (1) ◽  
pp. 16-17 ◽  
Author(s):  
RK Kundra ◽  
JD Moorehead ◽  
N Barton-Hanson ◽  
SC Montgomery
Keyword(s):  
Anterior Cruciate Ligament ◽  
Tracking System ◽  
Cruciate Ligament ◽  
Magnetic Tracking ◽  
Lachman Test ◽  
Acl Deficiency ◽  
Anterior Tibial ◽  
Anterior Cruciate ◽  
Tracking Device ◽  
Acl Deficient

INTRODUCTION The Lachman test is commonly performed as part of the routine assessment of patients with suspected anterior cruciate ligament (ACL) deficiency. A major drawback is its reliance on the clinician's subjective judgement of movement. The aim of this study was to quantify Lachman movement using a magnetic tracking device thereby providing a more accurate objective measure of movement. PATIENTS AND METHODS Ten patients aged 21–51 years were assessed as having unilateral ACL deficiency with conventional clinical tests. These patients were then re-assessed using a Polhemus Fastrak™ magnetic tracking device. RESULTS The mean anterior tibial displacement was 5.6 mm (SD = 2.5) for the normal knees and 10.2 mm (SD = 4.2) for the ACL-deficient knees. This gave an 82% increase in anterior tibial displacement for the ACL deficient knees. This was shown to be highly significant with P = 0.005. CONCLUSIONS The magnetic tracking system offers an objective quantification of displacements during the Lachman test. It is convenient, non-invasive and comfortable for the patient and is, therefore, ideally suited for use as an investigative tool.

scholarly journals Effects of Anterior Cruciate Ligament Deficiency on Tibiofemoral Cartilage Thickness and Strains in Response to Hopping

2018 ◽  
Vol 47 (1) ◽  
pp. 96-103 ◽  
Author(s):  
E. Grant Sutter ◽  
Betty Liu ◽  
Gangadhar M. Utturkar ◽  
Margaret R. Widmyer ◽  
Charles E. Spritzer ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Acl Injury ◽  
Cartilage Thickness ◽  
Intercondylar Notch ◽  
Dynamic Activity ◽  
Acl Deficiency ◽  
Anterior Cruciate ◽  
Acl Deficient ◽  
Deficient Knee

Background: Changes in knee kinematics after anterior cruciate ligament (ACL) injury may alter loading of the cartilage and thus affect its homeostasis, potentially leading to the development of posttraumatic osteoarthritis. However, there are limited in vivo data to characterize local changes in cartilage thickness and strain in response to dynamic activity among patients with ACL deficiency. Purpose/Hypothesis: The purpose was to compare in vivo tibiofemoral cartilage thickness and cartilage strain resulting from dynamic activity between ACL-deficient and intact contralateral knees. It was hypothesized that ACL-deficient knees would show localized reductions in cartilage thickness and elevated cartilage strains. Study Design: Controlled laboratory study. Methods: Magnetic resonance images were obtained before and after single-legged hopping on injured and uninjured knees among 8 patients with unilateral ACL rupture. Three-dimensional models of the bones and articular surfaces were created from the pre- and postactivity scans. The pre- and postactivity models were registered to each other, and cartilage strain (defined as the normalized difference in cartilage thickness pre- and postactivity) was calculated in regions across the tibial plateau, femoral condyles, and femoral cartilage adjacent to the medial intercondylar notch. These measurements were compared between ACL-deficient and intact knees. Differences in cartilage thickness and strain between knees were tested with multiple analysis of variance models with alpha set at P < .05. Results: Compressive strain in the intercondylar notch was elevated in the ACL-deficient knee relative to the uninjured knee. Furthermore, cartilage in the intercondylar notch and adjacent medial tibia was significantly thinner before activity in the ACL-deficient knee versus the intact knee. In these 2 regions, thinning was significantly influenced by time since injury, with patients with more chronic ACL deficiency (>1 year since injury) experiencing greater thinning. Conclusion: Among patients with ACL deficiency, the medial femoral condyle adjacent to the intercondylar notch in the ACL-deficient knee exhibited elevated cartilage strain and loss of cartilage thickness, particularly with longer time from injury. It is hypothesized that these changes may be related to posttraumatic osteoarthritis development. Clinical Relevance: This study suggests that altered mechanical loading is related to localized cartilage thinning after ACL injury.

scholarly journals The Anterolateral Structure of the Knee Does Not Affect Anterior and Dynamic Rotatory Stability in Anterior Cruciate Ligament Injury: Quantitative Evaluation With the Electromagnetic Measurement System

2019 ◽  
Vol 47 (14) ◽  
pp. 3381-3388 ◽  
Author(s):  
Daisuke Araki ◽  
Takehiko Matsushita ◽  
Yuichi Hoshino ◽  
Kanto Nagai ◽  
Kyohei Nishida ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Lachman Test ◽  
Electromagnetic Measurement System ◽  
The Mean ◽  
Anterior Cruciate ◽  
Electromagnetic Measurement ◽  
Tibial Translation ◽  
Acl Deficient

Background: The biomechanical function of the anterolateral structure (ALS), which includes the anterolateral joint capsule and anterolateral ligament (ALL), remains a topic of debate. Hypothesis: The ALS contributes to knee joint stability during the Lachman test and the pivot-shift test in anterior cruciate ligament (ACL)–deficient knees. Study Design: Controlled laboratory study. Methods: Fourteen fresh-frozen hemipelvis lower limbs were used. For 7 specimens, the anterior one-third of the ALS and the residual ALS were cut intra-articularly with a radiofrequency device. Subsequently, the ACL was cut arthroscopically. For the other 7 specimens, the ACL was cut first, followed by the anterior one-third of the ALS and the residual ALS intra-articularly. During the procedures, the iliotibial band (ITB) was kept intact. At each condition, the anterior tibial translation (ATT) during the manual Lachman test and the acceleration of posterior tibial translation (APT) and the posterior tibial translation (PTT) during the manual pivot-shift test were measured quantitatively with an electromagnetic measurement system. The mean values of those parameters were compared among 6 groups (ACL intact, one-third ALS cut, all ALS cut, ACL cut, ACL/one-third ALS cut, and ACL/all ALS cut). Results: The mean ATTs during the Lachman test and the mean APTs and PTTs in the ACL-cut conditions (ACL cut, ACL/one-third ALS cut, and ACL/all ALS cut) were significantly larger than those under the ACL-intact conditions (ACL intact, one-third ALS cut, all ALS cut) ( P < .01). However, no statistically significant differences were observed among the intact, one-third ALS–cut, and all ALS–cut conditions, within the ACL-intact or ACL-cut conditions. Conclusion: Intra-articular dissection of the ALS did not increase the ATT during the Lachman test or the APT and PTT during the pivot-shift test under the intact condition of the ITB, regardless of the integrity of the ACL. When the ITB is intact, the ALS does not have a significant role in either anterior or dynamic rotatory knee stability, while the ACL does. Clinical Relevance: Recent growing interest about ALL reconstruction or ALS augmentation may not have a large role in controlling either anterior or dynamic rotatory knee instability in isolated ACL-deficient knees.

Effect of Femoral Antetorsion on Tibiofemoral Translation and Rotation in the Anterior Cruciate Ligament Deficient Knee

2018 ◽  
Vol 32 (10) ◽  
pp. 960-965
Author(s):  
Mohamed Omar ◽  
Yousif Al Saiegh ◽  
Emmanouil Liodakis ◽  
Timo Stuebig ◽  
Daniel Guenther ◽  
...  
Keyword(s):  
Distal Femur ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Femoral Antetorsion ◽  
Anterior Drawer ◽  
Tibial Translation ◽  
Acl Deficient ◽  
Deficient Knee

AbstractWe aimed to investigate how increased or decreased femoral antetorsion would affect the biomechanics of the knee in an anterior cruciate ligament (ACL)-deficient cadaveric model. We hypothesized that external or internal rotation of the distal femur, achieved through a femoral osteotomy, would affect the magnitude of tibiofemoral translation and rotation. Navigated measurements of tibiofemoral translation and rotation during the anterior drawer, Lachman, and pivot shift tests were performed on six whole-body cadaveric specimens in each of the following four conditions: native, ACL-deficient knee, ACL-deficient knee and 20-degree internal distal femur rotation, and ACL-deficient knee and 20-degree external distal femur rotation. Increased femoral antetorsion significantly reduced anterior tibial translation in the ACL-deficient knee during the anterior drawer, Lachman, and pivot shift tests (p < 0.05). Conversely, decreasing femoral antetorsion resulted in an increase in anterior tibial translation in the anterior drawer (nonsignificant), Lachman (p < 0.05), and pivot shift (p < 0.05) tests. Internally rotating the distal femur significantly reduced the magnitude of tibial rotation during the pivot shift test in the ACL-deficient knee (p < 0.05), whereas external rotation of the distal femur significantly increased tibial rotation (p < 0.05). The magnitude of femoral antetorsion affects tibiofemoral translation in an ACL-deficient cadaveric mode. Internally rotating the distal femur 20 degrees reduced the magnitude of tibial translation and rotation similar to that of the native knee, whereas externally rotating the distal femur aggravated translational and rotational instability.

There Are No Kinematic Differences Between Inframeniscal and Suprameniscal Anterolateral Ligament Injury in the Anterior Cruciate Ligament–Deficient Knee

2018 ◽  
Vol 46 (14) ◽  
pp. 3391-3399 ◽  
Author(s):  
Timothy A. Burkhart ◽  
Manoj Matthew ◽  
W. Scott McGuffin ◽  
Alexandra Blokker ◽  
David Holdsworth ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Internal Rotation ◽  
Knee Flexion ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Anterolateral Ligament ◽  
Anterior Cruciate ◽  
Acl Deficient ◽  
Deficient Knee

Background: Previous research demonstrated that the attachment of the anterolateral ligament (ALL) to the lateral meniscus is stiffer and stronger in its tibial attachment than its femoral attachment. How this relates to anterolateral knee stability and lateral meniscal function is unknown. Hypothesis/Purpose: The hypothesis was that the ALL acts as a peripheral anchor to the lateral meniscus, aiding in anterolateral rotatory stability, and that the inframeniscal fibers of the ALL will provide greater anterolateral rotatory stability because of their greater tensile properties. The purpose was therefore to compare the difference in kinematics of the anterior cruciate ligament (ACL)–deficient knee between the infra- and suprameniscal ALL-sectioned states. Study Design: Controlled laboratory study. Methods: Eight paired fresh-frozen cadaveric knees were tested in a 5–degree of freedom loading jig under the following loading conditions: 5-N·m internal rotation at 15° incremental angles of flexion and combined 5-N·m internal rotation moment, 10-N·m valgus moment, and 88-N anterior translation force representing a pivot shift test at 0°, 15°, and 30° of flexion. The knees were tested under intact, ACL-deficient, and ACL-/ALL-deficient conditions, with the pairs of knees being randomized to either supra- or inframeniscal ALL sectioning. Resultant joint kinematics and tibiofemoral translations were measured and compared with a 2-way mixed repeated measures analysis of variance. Results: Internal rotation increased by 3° after sectioning of the ACL at 0° of knee flexion ( P = .035). At 45° of knee flexion, internal rotation increased significantly by 2° between the ACL-deficient and the ACL-/ALL-deficient conditions ( P = .049). Secondary kinematics of valgus and anterior translation were observed in response to the 5-N·m load after ACL and ALL sectioning. Analysis of the pivot shift showed increases in tibiofemoral translation after sectioning of the ACL, with further translations after sectioning of the ALL. No differences were observed between supra- and inframeniscal ALL sectioning under any of the loading conditions. Conclusion: An injury to the ALL, coexisting with ACL deficiency, results in only minor increases in knee joint patholaxity. No differences in pivot-shift kinematics or tibiofemoral rotations were observed between the supra- and inframeniscal sectioning of the ALL in the ACL-deficient knee Clinical Relevance: Tears of the midbody and/or posterior root attachment of the lateral meniscus are often observed at the time of ACL reconstruction. Increased anterolateral rotatory laxity has been observed in both lateral meniscus– and ALL-deficient states in combination with an ACL injury. While no significant functional relationship was found between the ALL and lateral meniscus, ALL sectioning did result in increased knee joint patholaxity, as demonstrated by composite tibiofemoral rotations.

Incidence and Healing Rates of Meniscal Tears in Patients Undergoing Repair During the First Stage of 2-Stage Revision Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 47 (14) ◽  
pp. 3389-3395 ◽  
Author(s):  
Nicholas N. DePhillipo ◽  
Travis J. Dekker ◽  
Zachary S. Aman ◽  
David Bernholt ◽  
W. Jeffrey Grantham ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Meniscal Repair ◽  
Posterior Root ◽  
Meniscal Tears ◽  
Meniscus Root ◽  
Repair Technique ◽  
Anterior Cruciate ◽  
Acl Deficient ◽  
Inside Out

Background: Meniscal tears, including tears at the root attachment, have been associated with tears of the anterior cruciate ligament (ACL) in both primary and revision settings. However, there is a paucity of literature reporting the healing rates of meniscal repair during 2-stage revision ACL reconstruction (ACLR). Purpose: To evaluate the healing rates of meniscal repairs performed during 2-stage revision ACLR in ACL-deficient knees and to report the incidence of meniscus root tears in patients undergoing primary ACLR as compared with revision ACLR. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent primary and revision ACLR by a single surgeon were retrospectively identified. Revision ACLRs were grouped according to 1- or 2-stage ACLR. Meniscal tears were grouped according to laterality (medial, lateral) and location of tears. Meniscal repair technique was recorded, including transtibial or inside-out. Meniscal repair healing was assessed via second-look arthroscopy at the time of second-stage revision ACLR. Results: There were 1168 patients identified who underwent ACLR: 851 primary and 317 revision procedures. Sixty-four patients underwent meniscal repair during first-stage bone grafting in ACL-deficient knees, with an overall healing rate of 86%. The healing rates were 82.3% for meniscus root tears via the transtibial repair technique and 92.4% for meniscal peripheral tears via the inside-out repair technique. Meniscus root tears had overall incidences of 15.5% and 26.2% in primary and revision ACLRs, respectively. The incidence of lateral meniscus posterior root tears was approximately 4 times higher than of medial meniscus posterior root tears in both primary (12.2% vs 3.2%) and revision (20.5% vs 5.6%) ACLRs. Conclusion: A high incidence of meniscus root tears was found in patients undergoing revision ACLRs as compared with primary ACLRs. Meniscal repairs have a high rate of healing and success when performed during the first stage of revision ACLR in ACL-deficient knees.

scholarly journals Meniscal Allograft Transplantation After Anterior Cruciate Ligament Reconstruction Can Improve Knee Stability: A Comparison of Medial and Lateral Procedures

2020 ◽  
Vol 48 (10) ◽  
pp. 2370-2375
Author(s):  
Kyoung Ho Yoon ◽  
Hyun Woo Lee ◽  
Soo Yeon Park ◽  
Raymond D.K. Yeak ◽  
Jung-Suk Kim ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Rotational Stability ◽  
Pivot Shift Test ◽  
Meniscal Allograft Transplantation ◽  
Anterior Drawer ◽  
Stress Radiographs ◽  
Meniscal Allograft ◽  
Anterior Cruciate

Background: The purpose of this study was to evaluate the clinical score and stability after meniscal allograft transplantation (MAT) after a previous anterior cruciate ligament (ACL) reconstruction. Hypothesis: Medial MAT would improve anteroposterior stability, and lateral MAT would improve rotational stability. Study Design: Cohort study; Level of evidence, 3. Method: We retrospectively investigated 31 cases of MAT after a previous total or nearly total meniscectomy and ACL reconstruction between November 2008 and June 2017. Cases were divided into medial (16 cases) and lateral (15 cases) MAT groups. The patients were assessed preoperatively and at the 2-year follow-up. Results: In the medial MAT group, the International Knee Documentation Committee, Lysholm, Lysholm instability, and Tegner scores improved significantly at the 2-year follow-up, and there were also significant improvements in the anterior drawer, Lachman, and pivot-shift tests. In the lateral MAT group, the Lysholm and Tegner scores improved significantly at the 2-year follow-up, as had the anterior drawer and Lachman tests but not the pivot-shift test. The medial MAT group showed significant improvement in side-to-side difference on Telos stress radiographs, from 6.5 mm (preoperatively) to 3.6 mm (2-year follow-up) ( P = .001), while the lateral MAT group showed no significant change. There was no progression of arthritis in either group. Conclusion: Medial MAT improved not only anteroposterior stability but also rotational stability in the meniscus-deficient ACL-reconstructed knee. Lateral MAT showed improvements in the anterior drawer and Lachman tests but not in the pivot-shift test or side-to-side difference on Telos stress radiographs in meniscus-deficient ACL-reconstructed knees. Instability and pain are indications for MAT in meniscus-deficient ACL-reconstructed knees.

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