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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2018

01-08-2018 | Knee

Repair of the lateral posterior meniscal root improves stability in an ACL-deficient knee

Authors: Philipp Forkel, Constantin von Deimling, Lucca Lacheta, Florian B. Imhoff, Peter Foehr, Lukas Willinger, Felix Dyrna, Wolf Petersen, Andreas B. Imhoff, Rainer Burgkart

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2018

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Abstract

Purpose

To investigate the stabilizing effect of a lateral meniscus posterior root repair in an ACL and root deficient knee.

Methods

The hypothesis of the current study was that a sequential transection of the posterior root and the meniscofemoral ligaments in an ACL-deficient knee increases rotational instability, and conversely, a repair of the meniscus root reduces the internal tibial rotation. Therefore, eight human knee joints were tested in a robotic setup (5 N m internal torque, 50 N m anterior translation load). Five conditions were tested: intact, ACL cut, ACL cut + lateral meniscus posterior root tear (LMRT), ACL cut + LMRT + transection of the MFL and ACL cut + lateral meniscus root repair. The angles of internal tibial rotation as well as anterior tibial translation were recorded.

Results

Transection of the lateral meniscus posterior root increased the internal tibial instability as compared to the ACL-insufficient state. A significant increase was detected in 60° and 90° of flextion. Sectioning of the meniscofemoral ligament further destabilized the knees significantly at all flexion angles as compared to the ACL-deficient state. Even in 30°, 60° and 90° a significant difference was detected as compared to the isolated root tear. A tibial fixation of the lateral meniscus root reduced the internal tibial rotation in all flexion angles and led to a significant decrease of internal tibial rotation in 30° and 90° as compared to the transection of the root and the MFL. The anterior tibial translation was increased in all conditions as compared to the native state.

Conclusion

A lateral meniscus root repair can reduce internal tibial rotation in the ACL-deficient knee. To check the condition of the lateral posterior meniscus root attachment is clinical relevant as a lateral meniscus root repair might improve rotational stability.
Literature
1.
go back to reference Ahn JH, Bae TS, Kang KS, Kang SY, Lee SH (2011) Longitudinal tear of the medial meniscus posterior horn in the anterior cruciate ligament-deficient knee significantly influences anterior stability. Am J Sports Med 39(10):2187–2193CrossRefPubMed Ahn JH, Bae TS, Kang KS, Kang SY, Lee SH (2011) Longitudinal tear of the medial meniscus posterior horn in the anterior cruciate ligament-deficient knee significantly influences anterior stability. Am J Sports Med 39(10):2187–2193CrossRefPubMed
2.
go back to reference Ahn JH, Lee YS, Yoo JC, Chang MJ, Park SJ, Pae YR (2010) Results of arthroscopic all-inside repair for lateral meniscus root tear in patients undergoing concomitant anterior cruciate ligament reconstruction. Arthroscopy 26(1):67–75CrossRefPubMed Ahn JH, Lee YS, Yoo JC, Chang MJ, Park SJ, Pae YR (2010) Results of arthroscopic all-inside repair for lateral meniscus root tear in patients undergoing concomitant anterior cruciate ligament reconstruction. Arthroscopy 26(1):67–75CrossRefPubMed
3.
go back to reference Amadi HO, Gupte CM, Lie DT, McDermott ID, Amis AA, Bull AM (2008) A biomechanical study of the meniscofemoral ligaments and their contribution to contact pressure reduction in the knee. Knee Surg Sports Traumatol Arthrosc 16(11):1004–1008CrossRefPubMed Amadi HO, Gupte CM, Lie DT, McDermott ID, Amis AA, Bull AM (2008) A biomechanical study of the meniscofemoral ligaments and their contribution to contact pressure reduction in the knee. Knee Surg Sports Traumatol Arthrosc 16(11):1004–1008CrossRefPubMed
4.
go back to reference Amis AA, Bull AM, Gupte CM, Hijazi I, Race A, Robinson JR (2003) Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc 11(5):271–281CrossRefPubMed Amis AA, Bull AM, Gupte CM, Hijazi I, Race A, Robinson JR (2003) Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc 11(5):271–281CrossRefPubMed
5.
go back to reference Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 42(12):3016–3030CrossRefPubMed Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 42(12):3016–3030CrossRefPubMed
6.
go back to reference Cerminara AJ, LaPrade CM, Smith SD, Ellman MB, Wijdicks CA, LaPrade RF (2014) Biomechanical evaluation of a transtibial pull-out meniscal root repair: challenging the bungee effect. Am J Sports Med 42(12):2988–2995CrossRefPubMed Cerminara AJ, LaPrade CM, Smith SD, Ellman MB, Wijdicks CA, LaPrade RF (2014) Biomechanical evaluation of a transtibial pull-out meniscal root repair: challenging the bungee effect. Am J Sports Med 42(12):2988–2995CrossRefPubMed
7.
go back to reference Feucht MJ, Bigdon S, Mehl J, Bode G, Muller-Lantzsch C, Sudkamp NP, Niemeyer P (2014) Risk factors for posterior lateral meniscus root tears in anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 23(1):140–145CrossRefPubMed Feucht MJ, Bigdon S, Mehl J, Bode G, Muller-Lantzsch C, Sudkamp NP, Niemeyer P (2014) Risk factors for posterior lateral meniscus root tears in anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 23(1):140–145CrossRefPubMed
8.
go back to reference Feucht MJ, Grande E, Brunhuber J, Rosenstiel N, Burgkart R, Imhoff AB, Braun S (2014) Biomechanical comparison between suture anchor and transtibial pull-out repair for posterior medial meniscus root tears. Am J Sports Med 42(1):187–193CrossRefPubMed Feucht MJ, Grande E, Brunhuber J, Rosenstiel N, Burgkart R, Imhoff AB, Braun S (2014) Biomechanical comparison between suture anchor and transtibial pull-out repair for posterior medial meniscus root tears. Am J Sports Med 42(1):187–193CrossRefPubMed
9.
go back to reference Feucht MJ, Kuhle J, Bode G, Mehl J, Schmal H, Sudkamp NP, Niemeyer P (2015) Arthroscopic transtibial pullout repair for posterior medial meniscus root tears: a systematic review of clinical, radiographic, and second-look arthroscopic results. Arthroscopy 31(9):1808–1816CrossRefPubMed Feucht MJ, Kuhle J, Bode G, Mehl J, Schmal H, Sudkamp NP, Niemeyer P (2015) Arthroscopic transtibial pullout repair for posterior medial meniscus root tears: a systematic review of clinical, radiographic, and second-look arthroscopic results. Arthroscopy 31(9):1808–1816CrossRefPubMed
10.
go back to reference Forkel P, Foehr P, Meyer JC, Herbst E, Petersen W, Brucker PU, Burgkart R, Imhoff AB (2016) Biomechanical and viscoelastic properties of different posterior meniscal root fixation techniques. Knee Surg Sports Traumatol Arthrosc 25(2):403–410CrossRefPubMed Forkel P, Foehr P, Meyer JC, Herbst E, Petersen W, Brucker PU, Burgkart R, Imhoff AB (2016) Biomechanical and viscoelastic properties of different posterior meniscal root fixation techniques. Knee Surg Sports Traumatol Arthrosc 25(2):403–410CrossRefPubMed
11.
go back to reference 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(7):833–40CrossRefPubMed 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(7):833–40CrossRefPubMed
12.
go back to reference Forkel P, Petersen W (2012) Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL double-bundle reconstruction: technical note of a transosseous fixation using the tibial PL tunnel. Arch Orthop Trauma Surg 132(3):387–391CrossRefPubMed Forkel P, Petersen W (2012) Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL double-bundle reconstruction: technical note of a transosseous fixation using the tibial PL tunnel. Arch Orthop Trauma Surg 132(3):387–391CrossRefPubMed
13.
go back to reference Forkel P, Reuter S, Sprenker F, Achtnich A, Herbst E, Imhoff A, Petersen W (2015) Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system. Knee Surg Sports Traumatol Arthrosc 23(1):112–118CrossRefPubMed Forkel P, Reuter S, Sprenker F, Achtnich A, Herbst E, Imhoff A, Petersen W (2015) Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system. Knee Surg Sports Traumatol Arthrosc 23(1):112–118CrossRefPubMed
14.
go back to reference Frank JM, Moatshe G, Brady AW, Dornan GJ, Coggins A, Muckenhirn KJ, Slette EL, Mikula JD, LaPrade RF (2017) Lateral meniscus posterior root and meniscofemoral ligaments as stabilizing structures in the ACL-deficient knee: a biomechanical study. Orthop J Sports Med 5(6):2325967117695756CrossRefPubMedPubMedCentral Frank JM, Moatshe G, Brady AW, Dornan GJ, Coggins A, Muckenhirn KJ, Slette EL, Mikula JD, LaPrade RF (2017) Lateral meniscus posterior root and meniscofemoral ligaments as stabilizing structures in the ACL-deficient knee: a biomechanical study. Orthop J Sports Med 5(6):2325967117695756CrossRefPubMedPubMedCentral
15.
go back to reference Geeslin AG, Civitarese D, Turnbull TL, Dornan GJ, Fuso FA, LaPrade RF (2016) Influence of lateral meniscal posterior root avulsions and the meniscofemoral ligaments on tibiofemoral contact mechanics. Knee Surg Sports Traumatol Arthrosc 24(5):1469–1477CrossRefPubMed Geeslin AG, Civitarese D, Turnbull TL, Dornan GJ, Fuso FA, LaPrade RF (2016) Influence of lateral meniscal posterior root avulsions and the meniscofemoral ligaments on tibiofemoral contact mechanics. Knee Surg Sports Traumatol Arthrosc 24(5):1469–1477CrossRefPubMed
16.
go back to reference Gupte CM, Smith A, McDermott ID, Bull AM, Thomas RD, Amis AA (2002) Meniscofemoral ligaments revisited. Anatomical study, age correlation and clinical implications. J Bone Joint Surg Br 84(6):846–851CrossRefPubMed Gupte CM, Smith A, McDermott ID, Bull AM, Thomas RD, Amis AA (2002) Meniscofemoral ligaments revisited. Anatomical study, age correlation and clinical implications. J Bone Joint Surg Br 84(6):846–851CrossRefPubMed
17.
go back to reference Harnden E, Lin T, Wilson A, Reid JB 3rd (2017) Technique for transtibial knotless repair of lateral meniscus root avulsion. Arthrosc Tech 6(3):e845-e851CrossRefPubMedPubMedCentral Harnden E, Lin T, Wilson A, Reid JB 3rd (2017) Technique for transtibial knotless repair of lateral meniscus root avulsion. Arthrosc Tech 6(3):e845-e851CrossRefPubMedPubMedCentral
18.
go back to reference Johannsen AM, Civitarese DM, Padalecki JR, Goldsmith MT, Wijdicks CA, LaPrade RF (2012) Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci. Am J Sports Med 40(10):2342–2347CrossRefPubMed Johannsen AM, Civitarese DM, Padalecki JR, Goldsmith MT, Wijdicks CA, LaPrade RF (2012) Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci. Am J Sports Med 40(10):2342–2347CrossRefPubMed
19.
go back to reference Johnson DL, Swenson TM, Livesay GA, Aizawa H, Fu FH, Harner CD (1995) Insertion-site anatomy of the human menisci: gross, arthroscopic, and topographical anatomy as a basis for meniscal transplantation. Arthroscopy 11(4):386–394CrossRefPubMed Johnson DL, Swenson TM, Livesay GA, Aizawa H, Fu FH, Harner CD (1995) Insertion-site anatomy of the human menisci: gross, arthroscopic, and topographical anatomy as a basis for meniscal transplantation. Arthroscopy 11(4):386–394CrossRefPubMed
20.
go back to reference 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(2):363–369CrossRefPubMed 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(2):363–369CrossRefPubMed
21.
go back to reference 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(6):471–479CrossRefPubMed 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(6):471–479CrossRefPubMed
22.
go back to reference LaPrade RF, LaPrade CM, Ellman MB, Turnbull TL, Cerminara AJ, Wijdicks CA (2015) Cyclic displacement after meniscal root repair fixation: a human biomechanical evaluation. Am J Sports Med 43(4):892–898CrossRefPubMed LaPrade RF, LaPrade CM, Ellman MB, Turnbull TL, Cerminara AJ, Wijdicks CA (2015) Cyclic displacement after meniscal root repair fixation: a human biomechanical evaluation. Am J Sports Med 43(4):892–898CrossRefPubMed
23.
go back to reference LaPrade RF, LaPrade CM, James EW (2015) Recent advances in posterior meniscal root repair techniques. J Am Acad Orthop Surg 23(2):71–76CrossRefPubMed LaPrade RF, LaPrade CM, James EW (2015) Recent advances in posterior meniscal root repair techniques. J Am Acad Orthop Surg 23(2):71–76CrossRefPubMed
24.
go back to reference Lertwanich P, Martins CA, Kato Y, Ingham SJ, Kramer S, Linde-Rosen M, Smolinski P, Fu FH (2010) Contribution of the meniscofemoral ligament as a restraint to the posterior tibial translation in a porcine knee. Knee Surg Sports Traumatol Arthrosc 18(9):1277–1281CrossRefPubMed Lertwanich P, Martins CA, Kato Y, Ingham SJ, Kramer S, Linde-Rosen M, Smolinski P, Fu FH (2010) Contribution of the meniscofemoral ligament as a restraint to the posterior tibial translation in a porcine knee. Knee Surg Sports Traumatol Arthrosc 18(9):1277–1281CrossRefPubMed
25.
go back to reference Matheny LM, Ockuly AC, Steadman JR, LaPrade RF (2015) Posterior meniscus root tears: associated pathologies to assist as diagnostic tools. Knee Surg Sports Traumatol Arthrosc 23(10):3127–3131CrossRefPubMed Matheny LM, Ockuly AC, Steadman JR, LaPrade RF (2015) Posterior meniscus root tears: associated pathologies to assist as diagnostic tools. Knee Surg Sports Traumatol Arthrosc 23(10):3127–3131CrossRefPubMed
26.
go back to reference Minami T, Muneta T, Sekiya I, Watanabe T, Mochizuki T, Horie M, Katagiri H, Otabe K, Ohara T, Katakura M, Koga H (2017) Lateral meniscus posterior root tear contributes to anterolateral rotational instability and meniscus extrusion in anterior cruciate ligament-injured patients. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-017-4569-8 PubMedCrossRef Minami T, Muneta T, Sekiya I, Watanabe T, Mochizuki T, Horie M, Katagiri H, Otabe K, Ohara T, Katakura M, Koga H (2017) Lateral meniscus posterior root tear contributes to anterolateral rotational instability and meniscus extrusion in anterior cruciate ligament-injured patients. Knee Surg Sports Traumatol Arthrosc. https://​doi.​org/​10.​1007/​s00167-017-4569-8 PubMedCrossRef
27.
go back to reference Musahl V, Bedi A, Citak M, O’Loughlin P, Choi D, Pearle AD (2011) Effect of single-bundle and double-bundle anterior cruciate ligament reconstructions on pivot-shift kinematics in anterior cruciate ligament- and meniscus-deficient knees. Am J Sports Med 39(2):289–295CrossRefPubMed Musahl V, Bedi A, Citak M, O’Loughlin P, Choi D, Pearle AD (2011) Effect of single-bundle and double-bundle anterior cruciate ligament reconstructions on pivot-shift kinematics in anterior cruciate ligament- and meniscus-deficient knees. Am J Sports Med 39(2):289–295CrossRefPubMed
28.
go back to reference 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(8):1591–1597CrossRefPubMed 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(8):1591–1597CrossRefPubMed
29.
go back to reference Petersen W, Forkel P, Feucht MJ, Zantop T, Imhoff AB, Brucker PU (2014) Posterior root tear of the medial and lateral meniscus. Arch Orthop Trauma Surg 134(2):237–255CrossRefPubMed Petersen W, Forkel P, Feucht MJ, Zantop T, Imhoff AB, Brucker PU (2014) Posterior root tear of the medial and lateral meniscus. Arch Orthop Trauma Surg 134(2):237–255CrossRefPubMed
30.
go back to reference 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(11):2604–2609CrossRefPubMed 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(11):2604–2609CrossRefPubMed
31.
go back to reference Shelbourne KD, Roberson TA, Gray T (2011) Long-term evaluation of posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction. Am J Sports Med 39(7):1439–1443CrossRefPubMed Shelbourne KD, Roberson TA, Gray T (2011) Long-term evaluation of posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction. Am J Sports Med 39(7):1439–1443CrossRefPubMed
32.
go back to reference Shybut TB, Vega CE, Haddad J, Alexander JW, Gold JE, Noble PC, Lowe WR (2015) Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 43(4):905–911CrossRefPubMed Shybut TB, Vega CE, Haddad J, Alexander JW, Gold JE, Noble PC, Lowe WR (2015) Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 43(4):905–911CrossRefPubMed
Metadata
Title
Repair of the lateral posterior meniscal root improves stability in an ACL-deficient knee
Authors
Philipp Forkel
Constantin von Deimling
Lucca Lacheta
Florian B. Imhoff
Peter Foehr
Lukas Willinger
Felix Dyrna
Wolf Petersen
Andreas B. Imhoff
Rainer Burgkart
Publication date
01-08-2018
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-4949-8

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