scholarly journals Accuracy of magnetic resonance imaging for meniscal body tear in anterior cruciate ligament-deficient knees compared to anterior cruciate ligament-intact knee

2021 ◽  
Vol 2 ◽  
pp. 18-25
Author(s):  
Amit Joshi ◽  
Nagmani Singh ◽  
Bibek Basukala ◽  
Rohit Bista ◽  
Navin Tripathi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Meniscus Tear ◽  
Resonance Imaging ◽  
Anterior Cruciate ◽  
Acl Deficient ◽  
Deficient Knee ◽  
Intact Knee

Objectives: This prospective case–control study was conducted with primary aim to compare the value of magnetic resonance imaging (MRI) in terms of accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for the detection of meniscal tear in anterior cruciate ligament (ACL)-deficient and ACL-intact groups. The secondary aim was to identify if the sensitivity and accuracy differ if the MRI is older than 3 months from the time of surgery. Materials and Methods: There were 255 patients enrolled into this study out of which 207 fulfilled the inclusion criteria. Among 207, 138 underwent surgery within 1 month of MRI, 30 had 1–3 months delay, and 39 cases underwent surgery more than 3 months after their MRI. Among 167 patients who underwent surgery within 3 months of MRI, 97 had ACL tear and 71 had intact ACL. Results: The overall sensitivity for lateral meniscus tear (68.2%) is significantly lower than the medial meniscus tear (92.9%). The sensitivity of MRI for medial meniscus tear in ACL-deficient knee is lower than ACL-intact knees (90% vs. 96.2%, P = 0.3). Similarly, the sensitivity is significantly lesser for lateral meniscus tear in ACL-deficient knee compared to ACL-intact knee (50% vs. 83.3%, P = 0.009). The sensitivity of MRI for both the lateral and medial meniscus tear decreased if the MRI performed 3 months before the surgery. Conclusion: Patients with ACL-deficient knee have to be counseled for intraoperative detection of lateral meniscus tear as the sensitivity of MRI for lateral meniscus tear in ACL-deficient group is low. Similarly, if the MRI is more than 3 months old from the time of surgery, we recommend to repeat the MRI as the sensitivity decreases significantly.

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.

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.

scholarly journals Clinical, Magnetic Resonance Imaging, and Arthroscopic Correlation in Anterior Cruciate Ligament and Meniscal Injuries of the Knee

2018 ◽  
Vol 24 (1) ◽  
pp. 52-56
Author(s):  
Patel Ishani ◽  
Chandru Vijay ◽  
Nekkanti Supreeth ◽  
Renukarya Ravishankar ◽  
Reddy Vishnu Vardhan ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Predictive Value ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Resonance Imaging ◽  
Clinical Magnetic Resonance Imaging ◽  
Anterior Cruciate

Background The aim of this study is to compare and correlate the clinical, magnetic resonance imaging (MRI), and arthroscopy findings in anterior cruciate ligament (ACL) and meniscal injuries of the knee. Methods This was a prospective study of 30 cases of ACL and meniscal injuries of the knee admitted between September 2014 and May 2016, who underwent clinical examination, MRI, and arthroscopy of the knee. Results In our study of 30 cases, there were 26 male and four female patients with age ranging from 18 years to 60 years, with most patients in between 21 years and 30 years. Clinical examination had sensitivity of 90.91%, specificity of 100%, and accuracy of 93.33% for ACL, sensitivity of 83.33%, specificity of 77.78%, and accuracy of 80% for medial meniscus, and sensitivity of 75%, specificity of 77.27%, and accuracy of 76.67% for lateral meniscus. MRI had sensitivity of 95.45%, specificity of 87.5%, and accuracy of 93.33% for ACL, sensitivity of 91.67%, specificity of 55.56%, and accuracy of 70% for medial meniscus, and sensitivity of 62.5%, specificity of 72.73%, and accuracy of 70% for lateral meniscus. Conclusion In conclusion, the present study supports that clinical diagnosis is of primary necessity, as the positive predictive value is high for all the lesions. MRI is an additional diagnosing tool for ligament and meniscal injuries of the knee. Routine use of MRI to confirm the diagnosis is not indicated, as the positive predictive value is low, but can be used to exclude pathology, as the negative predictive value is high for all the lesions.

scholarly journals EFFECT OF SKELETAL MATURITY ON INCIDENCE OF ASSOCIATED MENISCAL AND CHONDRAL INJURIES IN ANTERIOR CRUCIATE LIGAMENT INJURED KNEES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0010
Author(s):  
Brett Heldt ◽  
Elsayed Attia ◽  
Raymond Guo ◽  
Indranil Kushare ◽  
Theodore Shybut
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Medial Meniscus ◽  
Skeletal Maturity ◽  
Cruciate Ligament ◽  
Demographic Data ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Meniscus Tears ◽  
Anterior Cruciate

Background: Acute anterior cruciate ligament(ACL) rupture is associated with a significant incidence of concomitant meniscal and chondral injuries. However, to our knowledge, the incidence of these concomitant injuries in skeletally immature(SI) versus skeletally mature(SM) patients has not been directly compared. SI patients are a unique subset of ACL patients because surgical considerations are different, and subsequent re-tear rates are high. However, it is unclear if the rates and types of meniscal and chondral injuries differ. Purpose: The purpose of this study is to compare associated meniscal and chondral injury patterns between SI and SM patients under age 21, treated with ACL reconstruction for an acute ACL tear. We hypothesized that no significant differences would be seen. Methods: We performed a single-center retrospective review of primary ACL reconstructions performed from January 2012 to April 2020. Patients were stratified by skeletal maturity status based on a review of records and imaging. Demographic data was recorded, including age, sex, and BMI. Associated intra-articular meniscal injury, including laterality, location, configuration, and treatment were determined. Articular cartilage injury location, grade, and treatments were determined. Revision rates, non-ACL reoperation rates, and time to surgery were also compared between the two groups. Results: 785 SM and 208 SI patients met inclusion criteria. Mean BMI and mean age were significantly different between groups. Meniscal tear rates were significantly greater in SM versus SI patients in medial meniscus tears(P<.001), medial posterior horn tears(P=.001), medial longitudinal tears configuration(P=.007), lateral Radial configuration(P=.002), and lateral complex tears(P=.011). Medial repairs(P<.001) and lateral partial meniscectomies(P=.004) were more likely in the SM group. There was a significantly greater number of chondral injuries in the SM versus SI groups in the Lateral(p=.007) and medial compartments(P<.001). SM patients had a significantly increased number of outerbridge grade 1 and 2 in the Lateral(P<.001) and Medial Compartments(P=.013). ACL revisions(P=.019) and Non-ACL reoperations(P=.002) were significantly greater in the SI patients compared to SM. No other significant differences were noted. Conclusion: SM ACL injured patients have a significantly higher rate of medial meniscus tears and medial longitudinal configurations treated with repair, and a significantly higher rate of radial and/or complex lateral meniscus tears treated with partial meniscectomy compared to the SI group. We also found a significantly higher rate of both medial and lateral compartment chondral injuries, mainly grades 1 and 2, in SM compared to SI patients. Conversely, SI ACL reconstruction patients had higher revision and subsequent non-ACL surgery rates.

scholarly journals Different anterolateral procedures have variable impact on knee kinematics and stability when performed in combination with anterior cruciate ligament reconstruction

2020 ◽  
pp. jisakos-2019-000360
Author(s):  
Thomas Neri ◽  
Danè Dabirrahmani ◽  
Aaron Beach ◽  
Samuel Grasso ◽  
Sven Putnis ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Rotational Laxity ◽  
Level Of Evidence ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Deficient Knee ◽  
Intact Knee

ObjectiveThe optimal anterolateral procedure to control anterolateral rotational laxity of the knee is still unknown. The objective was to compare the ability of five anterolateral procedures performed in combination with anterior cruciate ligament reconstruction (ACLR) to restore native knee kinematics in the setting of a deficient anterior cruciate ligament (ACL) and anterolateral structures.MethodsA controlled laboratory study was performed using 10 fresh-frozen cadaveric whole lower limbs with intact iliotibial band. Kinematics from 0° to 90° of flexion were recorded using a motion analysis three-dimensional (3D) optoelectronic system, allowing assessment of internal rotation (IR) and anteroposterior (AP) tibial translation at 30° and 90° of flexion. Joint centres and bony landmarks were calculated from 3D bone models obtained from CT scans. Intact knee kinematics were assessed initially, followed by sequential section of the ACL and anterolateral structures (anterolateral ligament, anterolateral capsule and Kaplan fibres). After ACLR, five anterolateral procedures were performed consecutively on the same knee: ALLR, modified Ellison, deep Lemaire, superficial Lemaire and modified MacIntosh. The last three procedures were randomised. For each procedure, the graft was fixed in neutral rotation at 30° of flexion and with a tension of 20 N.ResultsIsolated ACLR did not restore normal overall knee kinematics in a combined ACL plus anterolateral-deficient knee, leaving a residual tibial rotational laxity (p=0.034). Only the ALLR (p=0.661) and modified Ellison procedure (p=0.641) restored overall IR kinematics to the normal intact state. Superficial and deep Lemaire and modified MacIntosh tenodeses overconstrained IR, leading to shifted and different kinematics compared with the intact condition (p=0.004, p=0.001 and p=0.045, respectively). Compared with ACLR state, addition of an anterolateral procedure did not induce any additional control on AP translation at 30° and 90° of flexion (all p>0.05), except for the superficial Lemaire procedure at 90° (p=0.032).ConclusionIn biomechanical in vitro setting, a comparison of five anterolateral procedures revealed that addition of either ALLR or modified Ellison procedure restored overall native knee kinematics in a combined ACL plus anterolateral-deficient knee. Superficial and deep Lemaire and modified MacIntosh tenodeses achieved excellent rotational control but overconstrained IR, leading to a change from intact knee kinematics.Level of evidenceThe level-of-evidence statement does not apply for this laboratory experiments study.

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.

scholarly journals Evaluation of associated meniscal and chondral injuries in patients undergoing arthroscopic anterior cruciate ligament reconstruction

2021 ◽  
Vol 2 ◽  
pp. 34-40
Author(s):  
Prateek Gupta ◽  
Shakti Swaroop ◽  
Rakesh Arya
Keyword(s):  
Acl Reconstruction ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Acl Injury ◽  
Meniscus Tear ◽  
Chondral Lesions ◽  
Meniscal Lesions ◽  
Meniscus Lesions ◽  
Anterior Cruciate

Objectives: Anterior cruciate ligament (ACL) injury of the knee is commonly associated with meniscal and chondral lesions. This study was performed to assess the relative risk factors as well as the extent of the meniscal and chondral pathology at the time of arthroscopic ACL reconstruction. Materials and Methods: In this prospective study, patients undergoing ACL reconstruction were enrolled. Association of meniscal and chondral lesions was analyzed with age, sex, body mass index (BMI), mechanism of injury (sports-related or not), time gap between injury and surgery (<3 month and >3 months), and instability episodes. Logistic regression and Pearson Chi-square test were applied for evaluating the association. Results: A total of 55 patients (mean age 30 years [19–50 years]; 45 male:10 female) underwent arthroscopic ACL reconstruction, out of which 20 (36.3%) had isolated lateral meniscus tear, 14 (25.4%) had isolated medial meniscus tear, and 3 (5.4%) had both lateral and medial meniscus tear. BMI (P = 0.031) and instability episodes (P = 0.033) were predictor for meniscal lesions. Male sex was associated with significantly higher medial (P = 0.049) and lateral meniscal (P = 0.008) lesions. The older age group (>30 years) was associated with medial meniscus lesions (P = 0.047), while the younger age group (<30 years) had significantly higher lateral meniscal lesions (P = 0.008). Chronic ACL injuries (>3 months) had a significantly higher risk of medial meniscus lesions (P = 0.006). Age (>30 years) (P = 0.002) and obesity (BMI >30 kg/m2) (P = 0.043) were predictors of chondral lesions. Conclusion: Significant association is observed between age (>30 years), male gender, obesity, and chronicity with medial meniscal injuries in patients with an ACL injury, while younger patients (<30 years) and patient operated within 3 months had a higher incidence of lateral meniscus lesions. Age and BMI (>30 kg/m2) were predictors of chondral lesions in ACL injury.

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