scholarly journals Small Lateral Meniscus Tears Propagate and are Detrimental to Knee Kinematics and Contact Forces

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0023
Author(s):  
Joao Novaretti ◽  
Elmar Herbst ◽  
Calvin Chan ◽  
Richard Debski ◽  
Volker Musahl
Keyword(s):  
Lateral Meniscus ◽  
Knee Kinematics ◽  
Contact Forces ◽  
Posterior Horn ◽  
Meniscus Tear ◽  
Tibiofemoral Joint ◽  
Meniscus Tears ◽  
Tear Propagation ◽  
Resultant Forces ◽  
Acl Deficient

Aims and Objectives: To quantify propagation of small vertical lateral meniscus tears located in the posterior horn during simulated cyclic cutting maneuvers on a robotic testing system and the resulting changes in knee kinematics and forces. Materials and Methods: 14 fresh-frozen human cadaveric knees (mean age: 74.8 ± 14.4) were mounted onto a 6-DOF robotic testing system. Knees with osteoarthritis greater than grade II were excluded. A small vertical tear in the posterior horn of the lateral meniscus medial to the popliteus tendon was created via a posterior arthrotomy. Tear length was measured with a custom-made device (accuracy 0.2 mm, inter-rater reliability 0.914). In 6 specimens, the ACL was resected arthroscopically, whereas in 8 knees the ACL was left intact. 10Nm valgus and 5Nm external rotation moment combined with 250N of axial compression were applied while the knees were continuously flexed from full extension to 90° of flexion for 500 cycles. Meniscus tear length was measured after each 100 cycles. After the measurements, the posterior capsule and skin were closed in a standardized fashion. Knee kinematics, the in situ force in the ACL, the resultant force in the lateral meniscus, and bony contact forces at the tibiofemoral joint were calculated at 30°, 60°, and 90° of knee flexion. A repeated measures ANOVA was used to compared the outcome parameters between knee states (p < 0.05). Results: In intact knees, small vertical lateral meniscus tears propagated significantly from baseline to 100, 200, 300, 400, and 500 cycles (all p < 0.001). This corresponds to a tear propagation of 28.7% ± 5.4%. Similarly, in ACL deficient knees meniscus tear propagation was significant throughout all sets of cycles (p = 0.001). This corresponds to a tear propagation of 26.1% ± 8.3%. While in intact knees, external tibial rotation was significantly increased by up to 45.5% after meniscus tear propagation, knee kinematics were not significantly affected in ACL deficient knees (NS). The resultant forces in the lateral meniscus increased with tear propagation in the intact knees by up to 54.1%. Likewise, the resultant forces in the lateral meniscus increased in the ACL deficient knees by up to 116.5% (p < 0.05). In intact knees, bony contact forces at the tibiofemoral joint increased with meniscus tear propagation by up to 91.9% (p < 0.05), which was comparable to ACL deficient knees. Conclusion: The data of this study suggest, that small vertical lateral meniscus tears propagate significantly regardless of the integrity of the ACL and after only 100 cycles of knee loading. The findings of the current robotic study are in contrast to recent clinical studies that found that small, vertical and stable tears in the posterior horn of the lateral meniscus could be left in situ. However, based on the current data, such tears do propagate over time regardless of the integrity of the ACL, which might alter knee kinematics and resultant forces in the lateral meniscus as well as bony contact forces at the tibiofemoral joint.

Medial and lateral meniscus have a different role in kinematics of the ACL-deficient knee: a systematic review

2019 ◽  
Vol 4 (5) ◽  
pp. 233-241
Author(s):  
Alberto Grassi ◽  
Giacomo Dal Fabbro ◽  
Stefano Di Paolo ◽  
Federico Stefanelli ◽  
Luca Macchiarola ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medial Meniscus ◽  
Lateral Meniscus ◽  
Meniscus Tear ◽  
Pivot Shift Test ◽  
Anterior Tibial ◽  
Kinematic Evaluation ◽  
Tibial Translation ◽  
Acl Deficient ◽  
Deficient Knee

ImportanceMeniscal tears are frequently associated with anterior cruciate ligament (ACL) injury and the correct management of this kind of lesion during ACL-reconstruction procedure is critical for the restoration of knee kinematics. Although the importance of meniscus in knee biomechanics is generally accepted, the influence of medial and lateral meniscus in stability of ACL-deficient knee is still unclear.ObjectiveThe aim of this study was to review literature, which analysed effects in cadaveric specimens of meniscal tear and meniscectomy of medial and lateral meniscus on laxity in the ACL-deficient knee.Evidence reviewAuthors performed a systematic search for cadaveric studies analysing the effect of medial and lateral meniscus tears or resection on kinematics of ACL-deficient knee. Extracted data included year of publications, number of human cadaver knee specimens, description of apparatus testing and instrumented kinematic evaluation, testing protocol and results.FindingsAuthors identified 18 studies that met inclusion and exclusion criteria of current review. The major finding of the review was that the works included reported a difference role of medial and lateral meniscus in restraining ACL-deficient knee laxity. Medial meniscus tear or resection resulted in a significant increase of anterior tibial displacement. Lateral meniscus lesions or meniscectomy on the other hand significantly increased rotation and translation under a coupled valgus stress and internal-rotation torque/pivot shift test.ConclusionsMedial and lateral meniscus have a different role in stabilising the ACL-deficient knee: while the medial meniscus functions as a critical secondary stabilisers of anterior tibial translation under an anterior/posterior load, lateral meniscus appears to be a more important restraint of rotational and dynamic laxity.Level of evidenceLevel IV, systematic review of level I–IV studies.

Tibiofemoral joint contact forces and knee kinematics during squatting

2008 ◽  
Vol 27 (3) ◽  
pp. 376-386 ◽  
Author(s):  
Stacey M. Smith ◽  
Robert A. Cockburn ◽  
Andrea Hemmerich ◽  
Rebecca M. Li ◽  
Urs P. Wyss
Keyword(s):  
Knee Kinematics ◽  
Contact Forces ◽  
Tibiofemoral Joint ◽  
Joint Contact

scholarly journals A Hospital Clinic Experience with Isolated Lateral Meniscal Tears in Sports: A Chart Review on Rugby

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Satoshi Ochiai ◽  
Tetsuo Hagino ◽  
Shinya Senga ◽  
Naofumi Taniguchi ◽  
Takashi Ando ◽  
...  
Keyword(s):  
Lateral Meniscus ◽  
High Sensitivity ◽  
Partial Meniscectomy ◽  
Return To Play ◽  
Meniscus Tear ◽  
Arthroscopic Partial Meniscectomy ◽  
Middle Segment ◽  
Meniscus Tears ◽  
Clinic Experience ◽  
Rugby Players

Background: Rugby is a contact sport, and the frequency of injuries is high. In our clinical experience with patients diagnosed arthroscopically with lateral meniscus tears in the middle segment, rugby players are more prevalent than players of other sports. We hypothesized that a meniscus tear in the middle segment is a common injury in rugby players and is associated with specific positions in rugby. Objectives: This study aimed to describe a series of lateral meniscus tears in rugby players. Methods: We retrospectively reviewed the medical charts of cases with an arthroscopically confirmed isolated lateral meniscus tear in the middle segment associated with rugby players in our center between 2006 and 2020. We investigated the epidemiology of injury, including the player position and phase of play, the symptoms; as well as imaging and arthroscopic findings. Results: Of 4452 cases (4666 knees) diagnosed arthroscopically with meniscus tears, 27 cases (28 knees) were isolated radial lateral meniscus tears in the middle segment, 26 of which were sports-associated, including 11 cases related to rugby. Among the 11 rugby players, 10 were forwards, 5 of whom were in the front row. The injury was associated with a tackle in 4 patients, while the phase of play of injury was unknown in 6 patients. In the clinical manual examination, tenderness and a positive hyperextension test had a relatively high sensitivity. In imaging examination, MRI depicted a characteristic image of a partial meniscal defect in the sagittal view. All patients underwent arthroscopic partial meniscectomy. The postoperative course was favorable. All patients returned to play rugby at the pre-injury competition level. Conclusions: In this study, radial lateral meniscus tears involving the middle segment frequently occurred in rugby players, mostly in forward positions. Arthroscopic partial meniscectomy achieved a return to play in all players.

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.

Different Regional Healing Rates with the Outside-In Technique for Meniscal Repair

1998 ◽  
Vol 26 (3) ◽  
pp. 446-452 ◽  
Author(s):  
Michiel F. van Trommel ◽  
Peter T. Simonian ◽  
Hollis G. Potter ◽  
Thomas L. Wickiewicz
Keyword(s):  
Medial Meniscus ◽  
Lateral Meniscus ◽  
Meniscal Repair ◽  
Current Method ◽  
Complete Healing ◽  
Posterior Horn ◽  
Resonance Imaging ◽  
Anterior Portion ◽  
Meniscus Tears

Fifty-one patients with meniscal repair using the outside-in technique were reassessed with second-look arthroscopic procedures (N 15), arthrographic examination (N 41), magnetic resonance imaging (N 36), or a combination of these techniques. Forty-one medial and 10 lateral menisci were repaired. The average clinical follow-up was 15 months (range, 3 to 80). Forty-five of 51 patients had tears that were located in or extended into the posterior horn of the medial or lateral meniscus. Complete healing occurred in 23 menisci (45%), partial healing was observed in 16 (15 medial, 1 lateral) (32%), and no healing occurred in 12 (24%). Remarkably, in all 15 patients who had tears extending from the posterior to the middle third of the medial meniscus that were partially healed, it was always the posterior third that had not fully healed. This finding is statistically significant. In addition, the middle third of these menisci had not fully healed in five patients. No healing occurred in the two patients with tears in the posterior third of the medial meniscus. Poor healing with the outside-in technique was observed in patients with tears into the posterior horn of the medial meniscus. For tears in the middle and anterior portion of the medial meniscus, as well as all lateral meniscus tears, the outside-in technique is our current method of choice.

Effects of Proud Large Osteochondral Plugs on Contact Forces and Knee Kinematics: A Robotic Study

2018 ◽  
Vol 46 (9) ◽  
pp. 2122-2127 ◽  
Author(s):  
Peter Z. Du ◽  
Keith L. Markolf ◽  
Daniel V. Boguszewski ◽  
Kent T. Yamaguchi ◽  
Christopher J. Lama ◽  
...  
Keyword(s):  
Lateral Meniscus ◽  
Knee Kinematics ◽  
Contact Forces ◽  
Osteochondral Allograft ◽  
Cartilage Defects ◽  
Tibial Rotation ◽  
Native Bone ◽  
Rotational Kinematics ◽  
Internal Tibial Rotation ◽  
Articular Cartilage Defects

Background: Osteochondral allograft (OCA) transplantation is used to treat large focal femoral condylar articular cartilage defects. A proud plug could affect graft survival by altering contact forces (CFs) and knee kinematics. Hypothesis: A proud OCA plug will significantly increase CF and significantly alter knee kinematics throughout controlled knee flexion. Study Design: Controlled laboratory study. Methods: Human cadaver knees had miniature load cells, each with a 20-mm-diameter cylinder of native bone/cartilage attached at its exact anatomic position, installed in both femoral condyles at standardized locations representative of clinical defects. Spacers were inserted to create proud plug conditions of +0.5, +1.0, and +1.5 mm. CFs and knee kinematics were recorded as a robot flexed the knee continuously from 0° to 50° under 1000 N of tibiofemoral compression. Results: CFs were increased significantly (vs flush) for all proudness conditions between 0° and 45° of flexion (medial) and 0° to 50° of flexion (lateral). At 20°, the average increases in medial CF for +0.5-mm, +1-mm, and +1.5-mm proudness were +80 N (+36%), +155 N (+70%), and +193 N (+87%), respectively. Corresponding increases with proud lateral plugs were +44 N (+14%), +90 N (+29%), and +118 N (+38%). CF increases for medial plugs at 20° of flexion were significantly greater than those for lateral plugs at all proudness conditions. At 50°, a 1-mm proud lateral plug significantly decreased internal tibial rotation by 15.4° and decreased valgus rotation by 2.5°. Conclusion: A proud medial or lateral plug significantly increased CF between 0° and 45° of flexion. Our results suggest that a medial plug at 20° may be more sensitive to graft incongruity than a lateral plug. The changes in rotational kinematics with proud lateral plugs were attributed to earlier contact between the proud plug’s surface and the lateral meniscus, leading to rim impingement with decreased tibial rotation. Clinical Relevance: Increased CF and altered knee kinematics from a proud femoral plug could affect graft viability. Plug proudness of only 0.5 mm produced significant changes in CF and knee kinematics, and the clinically accepted 1-mm tolerance may need to be reexamined in view of our findings.

Clinical Assessment Versus MRI Diagnosis of Meniscus Tears

2015 ◽  
Vol 24 (4) ◽  
pp. 423-427 ◽  
Author(s):  
Megan P. Brady ◽  
Windee Weiss
Keyword(s):  
Lateral Meniscus ◽  
The Elderly ◽  
Meniscus Tear ◽  
Specific Information ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Postoperative Rehabilitation ◽  
Clinical Exam ◽  
Meniscus Tears ◽  
Mri Diagnosis

Clinical Scenario:Common injuries in high-level and recreational athletes, nonathletes, and the elderly are medial and lateral meniscus tears. Diagnosis of meniscus tears is done with clinical exam, magnetic resonance imaging (MRI), and arthroscopy. The gold standard is arthroscopy, but accuracy of a clinical exam versus MRI diagnosis of meniscus tears is in question. A clinician’s ability to detect a meniscus tear is beneficial to the patient from a timing standpoint. The process of obtaining an MRI and results could be lengthy, but if the meniscus tear is accurately diagnosed clinically, the patient could be suspended from athletics or specific job duties to prevent further injury. In addition, rehabilitation could be initiated immediately, resulting in better outcomes for the patient. The ability to diagnose a meniscus tear clinically could initiate the rehabilitation process much sooner than waiting for MRI testing and results. Beginning the rehabilitation phase earlier may lead to faster postoperative rehabilitation and better patient outcomes. Clinical detection of a meniscus tear will facilitate possible suspension, early treatment, and rehabilitation recommendations, but the MRI will provide more specific information about the injury, including type and location of tear. Thus, surgical decisions such as operative versus nonoperative or meniscectomy versus repair would be based on MRI results.Focused Clinical Question:Is a clinical exam as accurate as an MRI scan for diagnosing meniscus tears?

scholarly journals Outcomes of Discoid Meniscus Repairs in Children and Adolescents

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0033
Author(s):  
Crystal A. Perkins ◽  
Michael T. Busch ◽  
Melissa A. Christino ◽  
S. Clifton Willimon
Keyword(s):  
Pediatric Patients ◽  
Lateral Meniscus ◽  
Meniscus Repair ◽  
Posterior Horn ◽  
Meniscus Tear ◽  
Inclusion Criteria ◽  
Discoid Meniscus ◽  
Tear Pattern ◽  
Meniscus Surgery

Objectives: Discoid meniscus tear patterns vary, but typically involve horizontal cleavage tears of the central discoid component with or without anterior or posterior meniscocapsular tears. Classically, the central discoid component is saucerized and meniscocapsular tears are repaired. Recent data suggests that meniscal preservation provides long-term benefits over resection1-2. However, many meniscal transplants are performed secondary to unsalvaged or unsalvageable discoid meniscus tears3. Reoperation rates after meniscus repairs vary greatly4-6, with some series reporting high rates of reinjury and reoperation, but there are no large series of pediatric discoid meniscus repairs in the literature. The purpose of this study is to describe the outcomes of meniscus repair and saucerization in pediatric patients with symptomatic discoid menisci. Methods: A single-institution retrospective review was performed of consecutive pediatric patients with surgical treatment of a discoid meniscus tear over a five-year period. Inclusion criteria were age less than 18 years, a symptomatic torn discoid meniscus treated with knee arthroscopy with meniscus repair, and minimum 4-month follow-up. A chart review was performed to describe tear location, tear pattern, and repair type (inside-out, outside-in, all-inside, and hybrid). Hybrid repair constructs were defined as those that used 2 or more repair types. The primary outcome was revision meniscus surgery. Results: Forty-four patients were identified to meet inclusion criteria. There were 23 males and 21 females with a mean age of 12.4 years (range 5 - 17 years). The right knee was affected in 61% of patients. The lateral meniscus was involved in all patients. Tear patterns included anterior meniscocapsular (19 patients, 43%), posterior meniscocapsular (14 patients, 30%), radial (7 patients, 16%), and bucket-handle (5 patients, 11%). Tears most commonly involved the posterior horn and body (21 patients, 48%) or posterior horn (16 patients, 36%) Arthroscopic meniscus repair was performed in all patients. Forty-three patients (98%) also underwent saucerization. Marrow stimulation, as a biological approach to improve repair healing, was performed in 14 patients (32%). The distribution of repair types and number of sutures for each type is listed in the table below. Mean follow-up was 19 months (range 4 - 70 months). Four patients (9%) underwent revision meniscus surgery following the primary repair, including 2 all-inside repairs and 2 partial meniscectomies. There were no statistically significant differences between patients who did or did not require a secondary surgery with respect to sex, age, tear location, tear pattern, repair type, or number of sutures. During follow-up, 9 patients (20%) had surgery for a symptomatic discoid meniscus in the contralateral knee. Conclusion: Saucerization and repair of discoid lateral meniscus tears in the pediatric population have good outcomes with low rates of reoperation. Appropriate saucerization, followed by an arthroscopic assessment of stability and tear patterns is critical to successful treatment of symptomatic discoid menisci. If tissue quality permits, meniscal preservation should be considered in all patients to avoid the consequences of subtotal meniscectomy. [Table: see text]

scholarly journals Development of OA Following ACL Reconstruction: Unexpected Finding in Medial Versus Lateral Meniscus Pathology

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0036
Author(s):  
Karen Briggs ◽  
Stephanie Petterson ◽  
Kevin Plancher
Keyword(s):  
Medial Meniscus ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Meniscal Repair ◽  
Meniscus Tear ◽  
Meniscus Tears ◽  
Medial Meniscal Tear ◽  
Lateral Meniscectomy ◽  
Meniscal Pathology

Objectives: Recent studies have described increased risk of OA following ACL reconstruction (ACLR). Systematic reviews have suggested that meniscal pathology, which occurs in up to 60% of patients with ACL injury, increases this risk. The literature reports a 50% incidence of OA following medial meniscectomy, two times the risk compared to lateral meniscectomy. The purpose of this study was to determine the influence of meniscal pathology on the incidence of OA following ACLR. Methods: All patients who underwent primary autograft or allograft BPTB transtibial ACLR by a single surgeon between 1999-2015 were identified. Revision ACLR, multi-ligamentous reconstructions, and patients with less than 2-year imaging follow-up were excluded. Meniscus pathology and treatment were recorded. OA was defined at follow-up as Kellgren-Lawrence grade III-IV on plain radiographs. Chi-square tests assessed differences in incidence rates (p<0.05). Results: A consecutive series of 103 patients (56 males, 47 females; age 36.1±11.4 years) with BPTB ACLR with an average follow-up of 8.81±4.96 (range 2-20 years) were included. The prevalence of medial meniscus tears at the time of ACL injury was 47.6% (49/103) and prevalence of lateral meniscus tears was 56.3% (58/103) (p=0.166). Medial compartment OA was seen in 9.7% (10/103) of patients. Prevalence of medial compartment OA was greater in patients with medial meniscus tear (14.3%; 7/49) compared to those without a medial meniscus tear (5.6%; 3/54); however, this was not significant (p=0.135). Of the 7 patients with medial meniscal tear and medial compartment OA, 5 underwent partial medial meniscectomy and 2 underwent repair. Lateral compartment OA was seen in 14.6% (15/103). The prevalence of lateral compartment OA was greater in patients with a lateral meniscus tear (22.4%; 13/58) compared to patients without lateral meniscus tears (4.4%; 2/45) (p=0.01). Patients with lateral meniscus tear were 5.04 [95%CI: 1.2 to 21.2] times more likely to develop OA. Thirteen of the 47 (28%) patients that underwent partial lateral meniscectomy developed lateral OA compared to 0% of patients (0/10) that underwent lateral meniscal repair (p=0.068). Conclusion: While studies with multiple surgeons and rehabilitation protocols have shown the development of OA following ACLR is increased with medial meniscal pathology, we found that the prevalence of medial OA was not significantly higher in these patients with medial meniscal tear at an average of 8.81 years follow-up. Whereas, lateral meniscal repair dramatically reduced the development of knee OA compared to partial meniscectomy in this cohort of patients with ACLR. These findings can inform clinical practice as despite prior literature indicating a relationship between medial meniscal tear and osteoarthritis, we did not see a greater prevalence of OA amongst patients undergoing ACLR with a medial meniscal tear. Further, a lateral meniscal repair offers superior protection against OA when compared to partial lateral meniscectomy in treating lateral meniscal tears and is essential in the treatment of these complex patients.

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