Download PDF
J Knee Surg 2021; 34(07): 784-792
DOI: 10.1055/s-0039-3402483
Original Article

Impact of Medial Meniscotibial Ligament Disruption Compared to Peripheral Medial Meniscal Tear on Knee Biomechanics

Patrick A. Smith
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
2   Columbia Orthopaedic Group, Columbia, Missouri
,
Joseph L. Humpherys
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
3   Department of Orthopaedic Surgery and Sports Medicine, Regional Health Orthopedic & Specialty Hospital, Rapid City, Missouri
,
James P. Stannard
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
4   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
,
James L. Cook
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
4   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
› Author Affiliations Funding This work was supported by The Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense, through the Peer Reviewed Orthopaedic Research Program under Award No. W81XWH-18-1-0430. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense.
› Further Information
    Permissions and Reprints

Abstract

Medial meniscotibial ligament (MTL) lesions may go unrecognized and untreated and have detrimental impact on knee biomechanics and joint pathology. Therefore, this study was designed to compare the biomechanical impact of midbody MTL disruption to corresponding peripheral medial meniscal (PMM) tears in anterior cruciate ligament (ACL) intact and ACL-deficient cadaveric knees. Cadaveric knees (n = 12; 6 matched pairs) were tested for laxity and ACL strain under anterior, valgus, and external rotation loading at 0, 30, and 90 degree of flexion. Knees were randomly assigned to ACL-intact (n = 6) or ACL-deficient (n = 6) groups. Large midbody MTL disruption or corresponding PMM tears were created (n = 3/group) and knees retested. PMM tears were repaired arthroscopically with inside-out suturing, and MTL lesions were repaired with suture anchors via an open approach. Knees were retested after repair. Biomechanical testing data were compared for statistically significant differences. Large MTL and PMM lesions were associated with significant increases in ACL strain, anterior laxity at 0, 30, and 90 degrees (p = 0.006), valgus laxity (p = 0.0012), and external rotation laxity (p = 0.0003) compared with intact knees. Repair of each lesion restored knee stability and reduced ACL strain to intact levels. In ACL-deficient knees, there was significantly increased anterior, valgus, and external rotation laxity compared with the ACL-intact state and MTL and PMM lesions further increased laxity at all angles. However, differences were not statistically significant and repair of meniscal lesions alone did not restore stability to ACL-deficient knees. These results highlight the need to recognize medial MTL injury and perform an appropriate repair procedure to restore knee stability and protect against excessive ACL strain.

Keywords

medial meniscus - meniscotibial ligament disruption - anterior cruciate ligament - biomechanics

Authors' Contributions

All authors have read and approved the final submitted manuscript. P.A.S., J.L.H., J.P.S., J.L.C.: substantial contributions to research design, acquisition, analysis of interpretation of data; P.A.S., J.L.H., J.P.S., J.L.C.: drafting the paper and revising it critically; P.A.S., J.L.H., J.P.S., J.L.C.: approval of the submitted and final versions.




Publication History

Received: 29 October 2019

Accepted: 11 November 2019

Article published online:
08 January 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Gianotti SM, Marshall SW, Hume PA, Bunt L. Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study. J Sci Med Sport 2009; 12 (06) 622-627
    CrossrefPubMedGoogle Scholar
  • 2 Swenson DM, Collins CL, Best TM, Flanigan DC, Fields SK, Comstock RD. Epidemiology of knee injuries among U.S. high school athletes, 2005/2006-2010/2011. Med Sci Sports Exerc 2013; 45 (03) 462-469
    CrossrefPubMedGoogle Scholar
  • 3 Liu X, Feng H, Zhang H, Hong L, Wang XS, Zhang J. Arthroscopic prevalence of ramp lesion in 868 patients with anterior cruciate ligament injury. Am J Sports Med 2011; 39 (04) 832-837
    CrossrefPubMedGoogle Scholar
  • 4 Ralles S, Agel J, Obermeier M, Tompkins M. Incidence of secondary intra-articular injuries with time to anterior cruciate ligament reconstruction. Am J Sports Med 2015; 43 (06) 1373-1379
    CrossrefPubMedGoogle Scholar
  • 5 Sims WF, Jacobson KE. The posteromedial corner of the knee: medial-sided injury patterns revisited. Am J Sports Med 2004; 32 (02) 337-345
    CrossrefPubMedGoogle Scholar
  • 6 Smith III JP, Barrett GR. Medial and lateral meniscal tear patterns in anterior cruciate ligament-deficient knees. A prospective analysis of 575 tears. Am J Sports Med 2001; 29 (04) 415-419
    CrossrefPubMedGoogle Scholar
  • 7 Yang N, Nayeb-Hashemi H, Canavan PK. The combined effect of frontal plane tibiofemoral knee angle and meniscectomy on the cartilage contact stresses and strains. Ann Biomed Eng 2009; 37 (11) 2360-2372
    CrossrefPubMedGoogle Scholar
  • 8 Yao J, Funkenbusch PD, Snibbe J, Maloney M, Lerner AL. Sensitivities of medial meniscal motion and deformation to material properties of articular cartilage, meniscus and meniscal attachments using design of experiments methods. J Biomech Eng 2006; 128 (03) 399-408
    CrossrefPubMedGoogle Scholar
  • 9 Zielinska B, Donahue TL. 3D finite element model of meniscectomy: changes in joint contact behavior. J Biomech Eng 2006; 128 (01) 115-123
    CrossrefPubMedGoogle Scholar
  • 10 Esmaili Jah AA, Keyhani S, Zarei R, Moghaddam AK. Accuracy of MRI in comparison with clinical and arthroscopic findings in ligamentous and meniscal injuries of the knee. Acta Orthop Belg 2005; 71 (02) 189-196
    PubMedGoogle Scholar
  • 11 Naranje S, Mittal R, Nag H, Sharma R. Arthroscopic and magnetic resonance imaging evaluation of meniscus lesions in the chronic anterior cruciate ligament-deficient knee. Arthroscopy 2008; 24 (09) 1045-1051
    CrossrefPubMedGoogle Scholar
  • 12 Sharifah MI, Lee CL, Suraya A, Johan A, Syed AF, Tan SP. Accuracy of MRI in the diagnosis of meniscal tears in patients with chronic ACL tears. Knee Surg Sports Traumatol Arthrosc 2015; 23 (03) 826-830
    CrossrefPubMedGoogle Scholar
  • 13 Sonnery-Cottet B, Conteduca J, Thaunat M, Gunepin FX, Seil R. Hidden lesions of the posterior horn of the medial meniscus: a systematic arthroscopic exploration of the concealed portion of the knee. Am J Sports Med 2014; 42 (04) 921-926
    CrossrefPubMedGoogle Scholar
  • 14 Granan LP, Bahr R, Lie SA, Engebretsen L. Timing of anterior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: a cohort study based on the Norwegian National Knee Ligament Registry. Am J Sports Med 2009; 37 (05) 955-961
    CrossrefPubMedGoogle Scholar
  • 15 DePhillipo NN, Moatshe G, Brady A. et al. Effect of meniscocapsular and meniscotibial lesions in ACL-deficient and ACL-reconstructed knees: a biomechanical study. Am J Sports Med 2018; 46 (10) 2422-2431
    CrossrefPubMedGoogle Scholar
  • 16 DePhillipo NN, Moatshe G, Chahla J. et al. Quantitative and qualitative assessment of the posterior medial meniscus anatomy: defining meniscal ramp lesions. Am J Sports Med 2019; 47 (02) 372-378
    CrossrefPubMedGoogle Scholar
  • 17 Strobel MJ. Manual of Arthroscopic Surgery. New York, NY: Springer; 1988
    Google Scholar
  • 18 Stephen JM, Halewood C, Kittl C, Bollen SR, Williams A, Amis AA. Posteromedial meniscocapsular lesions increase tibiofemoral joint laxity with anterior cruciate ligament deficiency, and their repair reduces laxity. Am J Sports Med 2016; 44 (02) 400-408
    CrossrefPubMedGoogle Scholar
  • 19 Bollier M, Smith PA. Anterior cruciate ligament and medial collateral ligament injuries. J Knee Surg 2014; 27 (05) 359-368
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Ahn JH, Bae TS, Kang KS, Kang SY, Lee SH. Longitudinal tear of the medial meniscus posterior horn in the anterior cruciate ligament-deficient knee significantly influences anterior stability. Am J Sports Med 2011; 39 (10) 2187-2193
    CrossrefPubMedGoogle Scholar
  • 21 Jonsson T, Althoff B, Peterson L, Renström P. Clinical diagnosis of ruptures of the anterior cruciate ligament: a comparative study of the Lachman test and the anterior drawer sign. Am J Sports Med 1982; 10 (02) 100-102
    CrossrefPubMedGoogle Scholar
  • 22 LaPrade CM, Jansson KS, Dornan G, Smith SD, Wijdicks CA, LaPrade RF. 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 2014; 96 (06) 471-479
    CrossrefPubMedGoogle Scholar
  • 23 Mariani PP. Posterior horn instability of the medial meniscus a sign of posterior meniscotibial ligament insufficiency. Knee Surg Sports Traumatol Arthrosc 2011; 19 (07) 1148-1153
    CrossrefPubMedGoogle Scholar
  • 24 Musahl V, Citak M, O'Loughlin PF, Choi D, Bedi A, Pearle AD. The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 2010; 38 (08) 1591-1597
    CrossrefPubMedGoogle Scholar
  • 25 Papageorgiou CD, Gil JE, Kanamori A, Fenwick JA, Woo SL-Y, Fu FH. The biomechanical interdependence between the anterior cruciate ligament replacement graft and the medial meniscus. Am J Sports Med 2001; 29 (02) 226-231
    CrossrefPubMedGoogle Scholar
  • 26 Peltier A, Lording T, Maubisson L, Ballis R, Neyret P, Lustig S. The role of the meniscotibial ligament in posteromedial rotational knee stability. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 2967-2973
    CrossrefPubMedGoogle Scholar
  • 27 Petrigliano FA, Musahl V, Suero EM, Citak M, Pearle AD. Effect of meniscal loss on knee stability after single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2011; 19 (Suppl. 01) S86-S93
    CrossrefPubMedGoogle Scholar
  • 28 Ravary B, Pourcelot P, Bortolussi C, Konieczka S, Crevier-Denoix N. Strain and force transducers used in human and veterinary tendon and ligament biomechanical studies. Clin Biomech (Bristol, Avon) 2004; 19 (05) 433-447
    CrossrefPubMedGoogle Scholar
  • 29 Seon JK, Gadikota HR, Kozanek M, Oh LS, Gill TJ, Li G. The effect of anterior cruciate ligament reconstruction on kinematics of the knee with combined anterior cruciate ligament injury and subtotal medial meniscectomy: an in vitro robotic investigation. Arthroscopy 2009; 25 (02) 123-130
    CrossrefPubMedGoogle Scholar
  • 30 LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L. The anatomy of the medial part of the knee. J Bone Joint Surg Am 2007; 89 (09) 2000-2010
    CrossrefPubMedGoogle Scholar
  • 31 Bikkina RS, Tujo CA, Schraner AB, Major NM. The “floating” meniscus: MRI in knee trauma and implications for surgery. AJR Am J Roentgenol 2005; 184 (01) 200-204
    CrossrefPubMedGoogle Scholar
  • 32 Arno S, Hadley S, Campbell KA. et al. The effect of arthroscopic partial medial meniscectomy on tibiofemoral stability. Am J Sports Med 2013; 41 (01) 73-79
    CrossrefPubMedGoogle Scholar
  • 33 Spang JT, Dang AB, Mazzocca A. et al. The effect of medial meniscectomy and meniscal allograft transplantation on knee and anterior cruciate ligament biomechanics. Arthroscopy 2010; 26 (02) 192-201
    CrossrefPubMedGoogle Scholar
  • 34 Trojani C, Sbihi A, Djian P. et al. Causes for failure of ACL reconstruction and influence of meniscectomies after revision. Knee Surg Sports Traumatol Arthrosc 2011; 19 (02) 196-201
    CrossrefPubMedGoogle Scholar