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

Grassi, Alberto; Fabbro, Giacomo Dal; Paolo, Stefano Di; Stefanelli, Federico; Macchiarola, Luca; Lucidi, Gian Andrea; Zaffagnini, Stefano

doi:10.1136/jisakos-2019-000293

Cited by 17 publications

(15 citation statements)

References 38 publications

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“…In addition to the ACL, the posterior horn of the lateral meniscus is a main rotation stabiliser of the knee joint, particularly during deep knee flexion [34,38]. LMM induced a significant rotational instability during all knee joint flexion in the knee joints, which was in accordance with the literature [13,38]. The GT autograft failed in restoring the rotational stability, whereas the doubled ST autograft achieved this.…”

Section: Joint Kinematicssupporting

confidence: 69%

Autologous semitendinosus meniscus graft restores the native knee joint kinematics and the tibiofemoral contact

Seitz

Leiprecht

Schwer

et al. 2022

Preprint

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Purpose Meniscectomy may lead to osteoarthritis. Autologous meniscus substitutes such as fat pads, perichondral tissue, facia-covered meniscus fragments and various tendons have been previously investigated for meniscal replacement in animal models. Recently, a clinical pilot study indicated promising outcomes by utilising a doubled semitendinosus tendon autograft. However, to date, no biomechanical data is available regarding this promising treatment alternative. Therefore, the aim of this in-vitro study on human knee joints was to investigate the potential of two autologous tendon meniscus replacements to restore the knee joint kinematics and tibiofemoral contact after total lateral meniscectomy (LMM). Methods The tibiofemoral loads and knee joint kinematics of fourteen left human cadaveric knee joints were investigated using an established knee joint simulator. Testing conditions included the intact, native state, total LMM and replacement using a single-bundle gracilis tendon (GT) and a doubled semitendinosus (ST) meniscus autograft. The joints were axially loaded with 200 N and exposed to no externally applied moments, external rotation, valgus stress and a combination of external rotation and valgus stress during three flexion-extension cycles (0° – 120°). Non-parametric statistical analyses were performed on joint kinematics, the tibiofemoral mean (CPmean) and peak (CPpeak) contact pressures and the contact area (CA). Results LMM led to significant rotational instability of the knee joint (p < 0.02). While the GT autograft procedure failed to restore joint kinematics, the ST autograft did restore the knee joint kinematics, except for knee joint flexions > 60°. The varus-valgus knee alignment was unaltered by any of the interventions. As expected, LMM significantly increased the CPmean and CPpeak (p < 0.03), while decreasing the CA (p < 0.05). The CPpeak was restored by ST autograft application, while the GT replacement displayed only a trend towards contact mechanics improvement compared to LMM. Conclusion The ST autograft displayed promising results in the initial restoration of the basic biomechanical knee joint function after total LMM. Future studies are required to optimise the tendon autograft procedure for total meniscus replacement and also in-vivo or clinical studies to better understand the remodelling process.

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Section: Joint Kinematicssupporting

confidence: 69%

Autologous semitendinosus meniscus graft restores the native knee joint kinematics and the tibiofemoral contact

Seitz

Leiprecht

Schwer

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…According to a 2019 systematic review, the medial meniscus was important for anteroposterior stability, and the lateral meniscus appeared to be a more important restraint of rotational and dynamic laxity. 13 This suggests that the lateral meniscus had a greater effect on the pivot shift; the medial meniscus, on the Lachman test. It is also possible that medial meniscal injury could be an effect (rather than a cause) of high-grade rotatory laxity.…”

Section: Discussionmentioning

confidence: 98%

“…Posterior third meniscal injuries (including posterior meniscus root and ramp injuries) were included for the analysis, as these were thought to be the most clinically important in terms of preventing anterior tibial translation and internal rotation. 1,13,40 Deficiency of the posterior third of the meniscus from a previous partial meniscectomy before ACL injury was classified as a tear for the purpose of this study. Bucket-handle tears were excluded, as they can limit the knee's ability to glide, a prerequisite to perform the pivot shift.…”

Section: Predictive Variablesmentioning

confidence: 99%

Association of Ligamentous Laxity, Male Sex, Chronicity, Meniscal Injury, and Posterior Tibial Slope With a High-Grade Preoperative Pivot Shift: A Post Hoc Analysis of the STABILITY Study

Batty¹,

Firth²,

Moatshe³

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: A spectrum of anterolateral rotatory laxity exists in anterior cruciate ligament (ACL)–injured knees. Understanding of the factors contributing to a high-grade pivot shift continues to be refined. Purpose: To investigate factors associated with a high-grade preoperative pivot shift and to evaluate the relationship between this condition and baseline patient-reported outcome measures (PROMs). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A post hoc analysis was performed of 618 patients with ACL deficiency deemed high risk for reinjury. A binary logistic regression model was developed, with high-grade pivot shift as the dependent variable. Age, sex, Beighton score, chronicity of the ACL injury, posterior third medial or lateral meniscal injury, and tibial slope were selected as independent variables. The importance of knee hyperextension as a component of the Beighton score was assessed using receiver operator characteristic curves. Baseline PROMs were compared between patients with and without a high-grade pivot. Results: Six factors were associated with a high-grade pivot shift: Beighton score (each additional point; odds ratio [OR], 1.17; 95% CI, 1.06-1.30; P = .002), male sex (OR, 2.30; 95% CI, 1.28-4.13; P = .005), presence of a posterior third medial (OR, 2.55; 95% CI, 1.11-5.84; P = .03) or lateral (OR, 1.76; 95% CI, 1.01-3.08; P = .048) meniscal injury, tibial slope >9° (OR, 2.35; 95% CI, 1.09-5.07; P = .03), and chronicity >6 months (OR, 1.70; 95% CI, 1.00-2.88; P = .049). The presence of knee hyperextension improved the diagnostic utility of the Beighton score as a predictor of a high-grade pivot shift. Tibial slope <9° was associated with only a high-grade pivot in the presence of a posterior third medial meniscal injury. Patients with a high-grade pivot shift had higher baseline 4-Item Pain Intensity Measure scores than did those without a high-grade pivot shift (mean ± SD, 11 ± 13 vs 8 ± 14; P = .04); however, there was no difference between groups in baseline International Knee Documentation Committee, ACL Quality of Life, Knee injury and Osteoarthritis Outcome Score, or Knee injury and Osteoarthritis Outcome Score subscale scores. Conclusion: Ligamentous laxity, male sex, posterior third medial or lateral meniscal injury, increased posterior tibial slope, and chronicity were associated with a high-grade pivot shift in this population deemed high risk for repeat ACL injury. The effect of tibial slope may be accentuated by the presence of meniscal injury, supporting the need for meniscal preservation. Baseline PROMs were similar between patients with and without a high-grade pivot shift.

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“…Previous studies have reported that concomitant LM injury in the setting of ACLR places a patient at higher risk of persistent knee laxity and thus, higher risk of subsequent injuries. [21,22] However, subjective knee function outcomes following ACLR with concomitant LM treatment are less studied. Thus, an increased understanding of the outcomes of several treatment methods of LM injury in the setting of primary ACLR would improve preoperative planning, postoperative outcomes, and patient education.…”

mentioning

confidence: 99%

Differences in Postoperative Knee Function Based on Concomitant Treatment of Lateral Meniscal Injury in the Setting of Primary ACL Reconstruction

Kaarre

Herman

Persson

et al. 2023

Preprint

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Background: Concomitant lateral meniscus (LM) injuries are common in acute anterior cruciate ligament (ACL) ruptures. However, the effect of addressing these injuries with various treatment methods during primary ACL reconstruction (ACLR) on patient-reported outcomes (PROs) is unknown. Therefore, the purpose of this study was to compare postoperative Knee injury and Osteoarthritis Outcome Score (KOOS) at 2-, 5-, and 10-years after isolated primary ACLR to primary ACLR with various treatment methods to address concomitant LM injury. Methods: This study was based on data from the Swedish National Knee Ligament Registry. Patients >15 years with data on postoperative KOOS who underwent primary ACLR between the years 2005 and 2018 were included in this study. The study population was divided into five groups: 1) Isolated ALCR, 2) ACLR + LM repair, 3) ACLR + LM resection, 4) ACLR+LM injury left in situ, and 5) ACLR + LM repair + LM resection. Patients with concomitant medial meniscus or other surgically treated ligament injuries were excluded. Results: Of 31,819 included patients, 24% had LM injury. After post hoc comparisons, significantly lower scores were found for the KOOS Symptoms subscale in ACLR+LM repair group compared to isolated ACLR (76.0 vs 78.3, p=0.0080) and ACLR+LM injury left in situ groups (76.0 vs 78.3, p=0.024) at 2-year follow-up. However, at 10-year follow-up, no differences were found between ACLR + LM repair and isolated ACLR, but ACLR + LM resection resulted in significantly lower KOOS Symptoms scores compared to isolated ACLR (80.4 vs 82.3, p=0.02). Conclusion: The results of this study suggest that LM injury during ACLR is associated with lower KOOS scores, particularly in the Symptoms subscale, at short- and long-term follow-up. Further randomized studies are needed to better understand the effects of various treatments for LM on clinical outcomes. Level of Evidence: III

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

Cited by 17 publications

References 38 publications

Autologous semitendinosus meniscus graft restores the native knee joint kinematics and the tibiofemoral contact

Autologous semitendinosus meniscus graft restores the native knee joint kinematics and the tibiofemoral contact

Association of Ligamentous Laxity, Male Sex, Chronicity, Meniscal Injury, and Posterior Tibial Slope With a High-Grade Preoperative Pivot Shift: A Post Hoc Analysis of the STABILITY Study

Differences in Postoperative Knee Function Based on Concomitant Treatment of Lateral Meniscal Injury in the Setting of Primary ACL Reconstruction

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