Partial Lateral Meniscectomy Affects Knee Stability Even in Anterior Cruciate Ligament-Intact Knees

Novaretti, João Victor; Lian, Jayson; Patel, Neel K.; Chan, Calvin K.; Cohen, Moisés; Musahl, Volker; Debski, Richard E.

doi:10.2106/jbjs.19.00712

Cited by 27 publications

(30 citation statements)

References 45 publications

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“…The results of the present study are in only partial alignment with 2 recent studies by Novaretti et al 24,25 ; they investigated the effect of lateral meniscectomy and lateral MAT in 10 cadaveric knees. Their methodology was based on 3 loading protocols (simulated Lachman maneuver, simulated pivot shift, and simulated cutting/pivoting movement) applied in the intact state after meniscal removal and lateral MAT.…”

Section: Discussionsupporting

confidence: 74%

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In Vivo Kinematic Analysis of Lateral Meniscal Allograft Transplantation With Soft Tissue Fixation

Macchiarola

Paolo

Grassi

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Lateral meniscal deficiency increases the pivot shift in the knee, and although meniscal allograft transplantation (MAT) is a well-established procedure with satisfactory clinical results, biomechanical studies have failed to show whether this procedure is able to restore knee kinematics. Purpose: To assess, in vivo, the kinematic effect of lateral MAT in anterior cruciate ligament–intact knees, with a particular focus on the pivot-shift maneuver. Study Design: Controlled laboratory study. Methods: Enrolled in this study were 10 consecutive patients undergoing lateral MAT. A surgical navigation system was used to acquire and quantify the following variables: anterior-posterior displacement at 30° of flexion (AP30) and 90° of flexion (AP90), varus-valgus rotation at 0° of flexion (VV0) and 30° of flexion, and dynamic laxity on the pivot-shift test, which was determined through anterior displacement of the lateral tibial compartment (APlat) and posterior acceleration of the lateral tibial compartment during tibial reduction (ACC). Data from before and after MAT were compared. Results: From pre- to postoperatively, there was a significant decrease in tibial translation of 2.8 mm (43%; P = .005) for AP30 and 1.9 mm (38%; P = .018) for AP90 as well as a significant difference of 3.6° (64%; P = .001) for VV0. There was also a significant pre- to postoperative reduction in the pivot shift of 7.4 mm (39%; P = .021) for APlat and 302.9 mm/s2 (75%; P = .005) for ACC. Conclusion: Lateral MAT improved knee kinematic parameters at time zero after surgery; the biomechanical effect of MAT was particularly evident during the pivot-shift maneuver.

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Section: Discussionsupporting

confidence: 74%

“…4 Specifically, several authors have demonstrated that a compromised lateral meniscus would produce a significant increase in the pivot-shift phenomenon in both anterior cruciate ligament (ACL)–intact and ACL-deficient knees. 8,23,24…”

mentioning

confidence: 99%

In Vivo Kinematic Analysis of Lateral Meniscal Allograft Transplantation With Soft Tissue Fixation

Macchiarola

Paolo

Grassi

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Biomechanical studies support these findings, demonstrating increased in situ forces on ACL grafts and alteration of joint kinematics in meniscus-deficient knees. 25 , 31 , 32 While concurrent MCL injury is a known risk factor for revision surgery after ACLR, there is a scarcity of data on the effect of concurrent meniscal injury/surgery in pediatric patients. 41 In 2019, Cordasco et al 4 demonstrated no difference in the incidence of revision ACLR surgery in a cohort of patients <20 years old who had concomitant meniscal repair or meniscectomy.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Failure After Anterior Cruciate Ligament Reconstruction in a Pediatric Population: A Prediction Algorithm

Lemme

Yang

Barrow

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Anterior cruciate ligament reconstruction (ACLR) in pediatric patients is becoming increasingly common. There is growing yet limited literature on the risk factors for revision in this demographic. Purpose: To (1) determine the rate of pediatric revision ACLR in a nationally representative sample, (2) ascertain the associated patient- and injury-specific risk factors for revision ACLR, and (3) examine the differences in the rate and risks of revision ACLR between pediatric and adult patients. Study Design: Case-control study; Level of evidence, 3. Methods: The PearlDiver patient record database was used to identify adult patients (age ≥20 years) and pediatric patients (age <20 years) who underwent primary ACLR between 2010 and 2015. At 5 years postoperatively, the risk of revision ACLR was compared between the adult and pediatric groups. ACLR to the contralateral side was also compared. Multivariate logistic regression was used to determine the significant risk factors for revision ACLR and the overall reoperation rates in pediatric and adult patients; from these risk factors, an algorithm was developed to predict the risk of revision ACLR in pediatric patients. Results: Included were 2055 pediatric patients, 1778 adult patients aged 20 to 29 years, and 1646 adult patients aged 30 to 39 years who underwent ACLR. At 5 years postoperatively, pediatric patients faced a higher risk of revision surgery when compared with adults (18.0 % vs 9.2% [adults 20-29 years] and 7.1% [adults 30-39 years]; P < .0001), with significantly decreased survivorship of the index ACLR ( P < .0001; log-rank test). Pediatric patients were also at higher risk of undergoing contralateral ACLR as compared with adults (5.8% vs 1.6% [adults 20-29 years] and 1.9% [adults 30-39 years]; P < .0001). Among the pediatric cohort, boys (odds ratio [OR], 0.78; 95% CI, 0.63-0.96; P = .0204) and patients >14 years old (OR, 0.62; 95% CI, 0.45-0.86; P = .0035) had a decreased risk of overall reoperation; patients undergoing concurrent meniscal repair (OR, 1.84; 95% CI, 1.43-2.38; P < .0001) or meniscectomy (OR, 2.20; 95% CI, 1.72-2.82; P < .0001) had an increased risk of revision surgery. According to the risk algorithm, the highest probability for revision ACLR was in girls <15 years old with concomitant meniscal and medial collateral ligament injury (36% risk of revision). Conclusion: As compared with adults, pediatric patients had an increased likelihood of revision ACLR, contralateral ACLR, and meniscal reoperation within 5 years of an index ACLR. Families of pediatric patients—especially female patients, younger patients, and those with concomitant medial collateral ligament and meniscal injuries—should be counseled on such risks.

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“…Partial or total meniscectomy leads to an alteration of the biomechanics and kinematics of the knee [ 22 , 32 , 33 ]. Although meniscal resection may be followed by a rapid improvement of clinical symptoms, a subset of patients suffer from nagging pain after a certain period of time.…”

Section: Anatomical and Biomechanical Considerationsmentioning

confidence: 99%

“…The clinical benefit of scaffold-based partial meniscal substitution is more evident in the chronic rather than acute settings (Table 1 ). This appears to be controversial, since a loss of meniscal tissue has been shown to instantly alter knee joint biomechanics [ 32 , 33 ]. The rapid improvement of clinical symptoms after partial meniscectomy following an acute meniscal lesion may be an explanation.…”

Section: Principles Of Meniscal Substitutionmentioning

confidence: 99%

Meniscal substitution, a developing and long-awaited demand

et al. 2020

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The menisci represent indispensable intraarticular components of a well-functioning knee joint. Sports activities, traumatic incidents, or simply degenerative conditions can cause meniscal injuries, which often require surgical intervention. Efforts in biomechanical and clinical research have led to the recommendation of a meniscus-preserving rather than a meniscusresecting treatment approach. Nevertheless, partial or even total meniscal resection is sometimes inevitable. In such circumstances, techniques of meniscal substitution are required. Autologous, allogenic, and artificial meniscal substitutes are available which have evolved in recent years. Basic anatomical and biomechanical knowledge, clinical application, radiological and clinical outcomes as well as future perspectives of meniscal substitutes are presented in this article. A comprehensive knowledge of the different approaches to meniscal substitution is required in order to integrate these evolving techniques in daily clinical practice to prevent the devastating effects of lost meniscal tissue.

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Partial Lateral Meniscectomy Affects Knee Stability Even in Anterior Cruciate Ligament-Intact Knees

Cited by 27 publications

References 45 publications

In Vivo Kinematic Analysis of Lateral Meniscal Allograft Transplantation With Soft Tissue Fixation

In Vivo Kinematic Analysis of Lateral Meniscal Allograft Transplantation With Soft Tissue Fixation

Risk Factors for Failure After Anterior Cruciate Ligament Reconstruction in a Pediatric Population: A Prediction Algorithm

Meniscal substitution, a developing and long-awaited demand

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