The Effect of Medial Meniscectomy and Meniscal Allograft Transplantation on Knee and Anterior Cruciate Ligament Biomechanics
Received 14 June 2009; accepted 11 November 2009.
Purpose
Our purpose was to evaluate the effect of meniscectomy and meniscal allograft transplant on anterior cruciate ligament (ACL) and knee biomechanics.
Methods
A differential variable reluctance transducer was placed in the ACL of 10 human cadaveric knees to record strain. Tibial displacement from a neutral reference was recorded relative to the position of the femur. Testing was performed at 30°, 60°, and 90° of knee flexion. Six cycles of anterior-posterior loads were applied to the limit of 150 N. After a testing cycle, a medial meniscectomy was performed and the testing cycle was repeated. A meniscal allograft transplant was performed, and a final testing cycle was conducted. ACL strain and tibial displacement in the meniscectomy and meniscal allograft states were compared with the intact-knee state.
Results
Tibial displacement after meniscectomy significantly increased at all angles. The meniscal allograft transplant restored tibial displacement to normal values at 30° and 90°. ACL strain increased significantly after meniscectomy at 60° and 90° of flexion, and meniscal allograft transplant returned the strain values to normal at 60° and 90°.
Conclusions
In most cases medial meniscectomy produced a significant increase in tibial displacement relative to the femur, and meniscal allograft transplantation restored displacement values to normal. Meniscectomy increased ACL strain and meniscal allograft transplant restored strain values to normal in 2 of 3 tested flexion angles.
Clinical Relevance
The absence of the medial meniscus exposes the ACL to increased strain, whereas meniscal allograft lowered the strain on the native ACL. This could have implications for those patients undergoing ACL reconstruction who have concomitant removal of the medial meniscus.
aDepartment of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
bDepartment of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, Connecticut
cDepartment of Orthopaedics & Rehabilitation, McClure Musculoskeletal Research Center, University of Vermont, Burlington, Vermont, U.S.A.
Address correspondence and reprint requests to Robert A. Arciero, M.D., New England Musculoskeletal Institute, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030, U.S.A.
Supported by the Orthopaedic Research and Education Foundation, Arthrex, and AlloSource. The authors report no conflict of interest.
ABSTRACT