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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2018

01-04-2018 | Knee

Lateral meniscus posterior root tear contributes to anterolateral rotational instability and meniscus extrusion in anterior cruciate ligament-injured patients

Authors: Takao Minami, Takeshi Muneta, Ichiro Sekiya, Toshifumi Watanabe, Tomoyuki Mochizuki, Masafumi Horie, Hiroki Katagiri, Koji Otabe, Toshiyuki Ohara, Mai Katakura, Hideyuki Koga

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2018

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Abstract

Purpose

The purposes of this study were to investigate (1) meniscus status and clinical findings in anterior cruciate ligament (ACL)-injured patients to clarify associations between the meniscus posterior root tear (PRT) and knee instability, and (2) magnetic resonance imaging (MRI) findings of the PRT to clarify sensitivity and specificity of MRI and prevalence of meniscus extrusion.

Methods

Three hundred and seventeen patients with primary ACL reconstruction were included. PRTs for both medial and lateral sides were confirmed by reviewing surgical records. Preoperative MRI was reviewed to evaluate sensitivity and specificity of the PRT and meniscus extrusion width (MEW). Clinical information regarding the number of giving-way episodes, preoperative KT-1000 measurements and preoperative pivot shift was also assessed.

Results

Thirty-nine patients had a lateral meniscus (LM) PRT, whereas only four patients had a medial meniscus PRT. One hundred and seventeen patients had no meniscus tear (control). Twenty-eight patients (71.8%) showed positive signs of the LMPRT based on at least one view of MR images, with the coronal view showing the highest sensitivity. MEW in the LMPRT group was significantly larger than that in the control group. The preoperative pivot shift test grade in the LMPRT group was significantly greater than that in the control group. There were no significant differences in other parameters.

Conclusions

In ACL-injured patients, the LMPRT was associated with ALRI as well as with meniscus extrusion. The coronal view of MRI was useful in identifying the LMPRT, although its sensitivity was not high. Therefore, surgeons should prepare to repair PRTs at the time of ACL reconstruction regardless of MRI findings, and they should make every effort to repair the LMPRT.

Level of evidence

III.
Literature
1.
Anderson L, Watts M, Shapter O et al (2010) Repair of radial tears and posterior horn detachments of the lateral meniscus: minimum 2-year follow-up. Arthroscopy 26:1625–1632CrossRefPubMed
2.
Ayeni OR, Chahal M, Tran MN, Sprague S (2012) Pivot shift as an outcome measure for ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 20:767–777CrossRefPubMed
3.
Berthiaume MJ, Raynauld JP, Martel-Pelletier J et al (2005) Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging. Ann Rheum Dis 64:556–563CrossRefPubMed
4.
Brandon ML, Haynes PT, Bonamo JR, Flynn MI, Barrett GR, Sherman MF (2006) The association between posterior-inferior tibial slope and anterior cruciate ligament insufficiency. Arthroscopy 22:894–899CrossRefPubMed
5.
Brody JM, Lin HM, Hulstyn MJ, Tung GA (2006) Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear. Radiology 239:805–810CrossRefPubMed
6.
Choi SH, Bae S, Ji SK, Chang MJ (2012) The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc 20:2098–2103CrossRefPubMed
7.
Costa CR, Morrison WB, Carrino JA (2004) Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? Am J Roentgenol 183:17–23CrossRef
8.
Daniel DM, Malcom LL, Losse G, Stone ML, Sachs R, Burks R (1985) Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am 67:720–726CrossRefPubMed
9.
De Smet AA, Blankenbaker DG, Kijowski R, Graf BK, Shinki K (2009) MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard. Am J Roentgenol 192:480–486CrossRef
10.
De Smet AA, Mukherjee R (2008) Clinical, MRI, and arthroscopic findings associated with failure to diagnose a lateral meniscal tear on knee MRI. Am J Roentgenol 190:22–26CrossRef
11.
Forkel P, Herbort M, Schulze M et al (2013) Biomechanical consequences of a posterior root tear of the lateral meniscus: stabilizing effect of the meniscofemoral ligament. Arch Orthop Trauma Surg 133:621–626CrossRefPubMed
12.
Forkel P, Herbort M, Sprenker F, Metzlaff S, Raschke M, Petersen W (2014) The biomechanical effect of a lateral meniscus posterior root tear with and without damage to the meniscofemoral ligament: efficacy of different repair techniques. Arthroscopy 30:833–840CrossRefPubMed
13.
Forkel P, Reuter S, Sprenker F et al (2015) Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system. Knee Surg Sports Traumatol Arthrosc 23:112–118CrossRefPubMed
14.
Guermazi A, Eckstein F, Hayashi D et al (2015) Baseline radiographic osteoarthritis and semi-quantitatively assessed meniscal damage and extrusion and cartilage damage on MRI is related to quantitatively defined cartilage thickness loss in knee osteoarthritis: the Multicenter Osteoarthritis Study. Osteoarthr Cartil 23:2191–2198CrossRefPubMedCentralPubMed
15.
Harper KW, Helms CA, Lambert HS 3rd, Higgins LD (2005) Radial meniscal tears: significance, incidence, and MR appearance. Am J Roentgenol 185:1429–1434CrossRef
16.
Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234CrossRefPubMed
17.
Hwang BY, Kim SJ, Lee SW et al (2012) Risk factors for medial meniscus posterior root tear. Am J Sports Med 40:1606–1610CrossRefPubMed
18.
Jonsson H, Riklund-Ahlstrom K, Lind J (2004) Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5–9 years after surgery. Acta Orthop Scand 75:594–599CrossRefPubMed
19.
Kittl C, El-Daou H, Athwal KK et al (2016) The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee. Am J Sports Med 44:345–354CrossRefPubMed
20.
Kocher MS, Steadman JR, Briggs K, Zurakowski D, Sterett WI, Hawkins RJ (2002) Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am 84:1560–1572CrossRefPubMed
21.
Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32:629–634CrossRefPubMed
22.
Koga H, Muneta T, Watanabe T et al (2016) Two-year outcomes after arthroscopic lateral meniscus centralization. Arthroscopy 32:2000–2008CrossRefPubMed
23.
Koga H, Muneta T, Yagishita K et al (2014) Effect of femoral tunnel position on graft tension curves and knee stability in anatomic double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 22:2811–2820CrossRefPubMed
24.
Kuroda R, Hoshino Y, Araki D et al (2012) Quantitative measurement of the pivot shift, reliability, and clinical applications. Knee Surg Sports Traumatol Arthrosc 20:686–691CrossRefPubMed
25.
LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF (2015) Meniscal root tears: a classification system based on tear morphology. Am J Sports Med 43:363–369CrossRefPubMed
26.
LaPrade CM, Jansson KS, Dornan G, Smith SD, Wijdicks CA, LaPrade RF (2014) Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs. J Bone Joint Surg Am 96:471–479CrossRefPubMed
27.
Lee DH, Lee BS, Kim JM et al (2011) Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 19:222–229CrossRefPubMed
28.
Lee YG, Shim JC, Choi YS, Kim JG, Lee GJ, Kim HK (2008) Magnetic resonance imaging findings of surgically proven medial meniscus root tear: tear configuration and associated knee abnormalities. J Comput Assist Tomogr 32:452–457CrossRefPubMed
29.
Lerer DB, Umans HR, Hu MX, Jones MH (2004) The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Skeletal Radiol 33:569–574CrossRefPubMed
30.
Levy IM, Torzilli PA, Warren RF (1982) The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am 64:883–888CrossRefPubMed
31.
Markolf KL, Jackson SR, McAllister DR (2012) Force measurements in the medial meniscus posterior horn attachment: effects of anterior cruciate ligament removal. Am J Sports Med 40:332–338CrossRefPubMed
32.
Marzo JM, Gurske-DePerio J (2009) Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications. Am J Sports Med 37:124–129CrossRefPubMed
33.
Monaco E, Ferretti A, Labianca L et al (2012) Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc 20:870–877CrossRefPubMed
34.
Musahl V, Citak M, O’Loughlin PF, Choi D, Bedi A, Pearle AD (2010) The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 38:1591–1597CrossRefPubMed
35.
Musahl V, Rahnemai-Azar AA, Costello J et al (2016) The influence of meniscal and anterolateral capsular injury on knee laxity in patients with anterior cruciate ligament injuries. Am J Sports Med 44:3126–3131CrossRefPubMed
36.
Nakajima H, Kondo M, Kurosawa H, Fukubayashi T (1979) Insufficiency of the anterior cruciate ligament. Review of our 118 cases. Arch Orthop Trauma Surg 95:233–240CrossRefPubMed
37.
Nakamura K, Koga H, Sekiya I et al (2015) Evaluation of pivot shift phenomenon while awake and under anaesthesia by different manoeuvres using triaxial accelerometer. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-015-3740-3
38.
Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, Tandogan RN (2008) Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 16:849–854CrossRefPubMed
39.
Rasmussen MT, Nitri M, Williams BT et al (2016) An in vitro robotic assessment of the anterolateral ligament, part 1: secondary role of the anterolateral ligament in the setting of an anterior cruciate ligament injury. Am J Sports Med 44:585–592CrossRefPubMed
40.
Robb C, Kempshall P, Getgood A et al (2015) Meniscal integrity predicts laxity of anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 23:3683–3690CrossRefPubMed
41.
Robinson J, Carrat L, Granchi C, Colombet P (2007) Influence of anterior cruciate ligament bundles on knee kinematics: clinical assessment using computer-assisted navigation. Am J Sports Med 35:2006–2013CrossRefPubMed
42.
Schillhammer CK, Werner FW, Scuderi MG, Cannizzaro JP (2012) Repair of lateral meniscus posterior horn detachment lesions: a biomechanical evaluation. Am J Sports Med 40:2604–2609CrossRefPubMed
43.
Shybut TB, Vega CE, Haddad J et al (2015) Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 43:905–911CrossRefPubMed
44.
Song GY, Zhang H, Wang QQ, Zhang J, Li Y, Feng H (2016) Risk factors associated with grade 3 pivot shift after acute anterior cruciate ligament injuries. Am J Sports Med 44:362–369CrossRefPubMed
Metadata
Title
Lateral meniscus posterior root tear contributes to anterolateral rotational instability and meniscus extrusion in anterior cruciate ligament-injured patients
Authors
Takao Minami
Takeshi Muneta
Ichiro Sekiya
Toshifumi Watanabe
Tomoyuki Mochizuki
Masafumi Horie
Hiroki Katagiri
Koji Otabe
Toshiyuki Ohara
Mai Katakura
Hideyuki Koga
Publication date
01-04-2018
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-017-4569-8

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