Natural evolution of popliteomeniscal fascicle tears over 2 years and its association with lateral articular knee cartilage degeneration in patients with traumatic anterior cruciate ligament tear

Abstract

Natural evolution of popliteomeniscal fascicle tears over 2 years and its association with lateral articular knee cartilage degeneration in patients with traumatic anterior cruciate ligament tear. Abstract Objectives To assess (i) normal imaging anatomy of the popliteomeniscal fascicles, (ii) prevalence and natural evolution of popliteomeniscal fascicle tears (PMFT) in subjects with traumatic anterior cruciate ligament (ACL) tears over 2 years and (iii) compare knee cartilage degeneration in subjects with and without PMFT longitudinally. Methods 57 subjects with ACL tears were screened for PMFT. Morphological (high-resolution 3D fast spin-echo) and compositional (T1ρ and T2 mapping) MR imaging was performed prior to and 2 years after ACL reconstruction. Differences of morphological and compositional parameters were compared between subjects with and without PMFT using logistic regression, adjusting for age, sex and BMI.Results In 24% (n = 14) of the subjects with ACL tear a PMFT was detected on baseline MRI. One subject with PMFT developed a meniscal tear over 2 years. Cartilage ΔT1ρ of the lateral femur increased significantly more in subjects with isolated PMFT compared to controls (mean difference, 2.0 ± 2.9 vs. −1.3 ± 1.6, p = 0.027).Conclusion PMFT detected by MRI are a common finding in subjects with ACL tears. Subjects with these defects showed higher compositional cartilage deterioration compared to controls, over 2 years in the lateral femoral compartment, indicating accelerated cartilage degeneration. Key Points• Popliteomeniscal fascicle lesions are a common finding in subjects with ACL tears.• Progression to a meniscal tear over 2 years is not frequent.• Anteroinferior popliteomeniscal fascicle is injured most frequently.• Patients with popliteomeniscal fascicle lesions showed accelerated cartilage degeneration.

The popliteomeniscal fascicles: from diagnosis to surgical repair: a systematic review of current literature

“…Finally, three articles were included for the qualitative analysis: LaPrade et al (2005) [ 30 ], Simonetta et al (2016) [ 18 ] and Kamiya et al (2018) [ 20 ]. Five articles were excluded with reasons: LaPrade et al (1997) [ 2 ] was excluded because, although an arthroscopic visualization of PMF tear with other associated lesions of PLC was reported, it is not specified whether and how PMFs were repaired; Steinbacher et al (2019) [ 23 ] and Van Steyn et al (2014) [ 22 ] were excluded because, although they report the surgical management of HLM, in their articles PMFs tears were not visualized and not identified as the cause of HLM; Guimaraes et al (2018) [ 8 ] was excluded because the surgical technique is not discussed; Suganuma et al (2012) [ 9 ] was excluded because, although an arthroscopic confirmation of PMF tears was performed, the surgical technique is not described.…”

“…The diagnosis, by imaging and clinical examination or arthroscopically, of disrupted PMFs remains very challenging [ 18 , 32 ]. Tears of PMFs are present in 80% of patients with an ACL tear or traumatic injury to the PLC [ 8 , 30 , 32 , 35 ]. In symptomatic patients, surgery is the gold standard to manage these injuries [ 21 , 36 ], although the most appropriate surgical technique is still debated [ 3 , 22 , 30 , 37 ].…”

“…The superior fascicle arises from the medial fibers of the aponeurosis of the popliteus tendon, and the inferior fascicle is a coronary ligament which connects the meniscus to the edge of the tibia [ 7 ]. A third incostant postero-inferior fascicle is sometime present [ 8 – 12 ]. PMFs, connecting the lateral meniscus at the popliteal hiatus [ 13 ], are thought to provide stability to the lateral meniscus, stabilizing the joint during internal rotation of the tibia and sudden changes of direction (Fig.…”

“…1 ) [ 4 , 14 – 17 ]. In particular, working in conjunction with the popliteus musculotendinous unit, the PMFs prevent excessive lateral meniscal movement and possible entrapment [ 8 ]. For this reason, athletes, such as martial artists, dancers, wrestlers and football players, whose activity is characterised by sudden changes of direction, rotational stresses, repetitive twisting and high jumps, are at higher risk of injuring the PMFs [ 3 , 8 , 18 ].…”

“…In particular, working in conjunction with the popliteus musculotendinous unit, the PMFs prevent excessive lateral meniscal movement and possible entrapment [ 8 ]. For this reason, athletes, such as martial artists, dancers, wrestlers and football players, whose activity is characterised by sudden changes of direction, rotational stresses, repetitive twisting and high jumps, are at higher risk of injuring the PMFs [ 3 , 8 , 18 ]. The injuries which affect the lateral meniscus lead to an increase of contact pressure and rotational instability, predisposing the joint to osteoarthritis as observed on radiographs [ 1 , 19 ].…”