Advertisement

The Biomechanical Effect of a Lateral Meniscus Posterior Root Tear With and Without Damage to the Meniscofemoral Ligament: Efficacy of Different Repair Techniques

      Purpose

      To evaluate the effect of the meniscofemoral ligament (MFL) in maintaining lateral-compartment contact pressures after injury to the posterior root of the lateral meniscus, and to measure the ability to restore intra-articular loads to normal by repairing the posterior root to the tibia after transection of the posterior root and the MFL.

      Methods

      Ten human cadaveric knee joints were axially loaded to 100 N. A digital pressure sensor measured the contact pressure in the lateral compartment. Five different conditions were tested: intact, after release of the posterior root of the lateral meniscus, after transection of the MFL along with release of the posterior root, refixation of the posterior root of the lateral meniscus to the tibia using an anatomic transosseous tunnel, and refixation of the root of the lateral meniscus using a tibial anterior cruciate ligament (ACL) tunnel.

      Results

      After transection of the posterior lateral meniscus root, the contact pressure did not increase significantly. The additional transection of the MFL led to a significant increase in the contact pressure. Anatomic fixation of the meniscus posterior horn reduced the femorotibial pressure to nearly pre-sectioning values. The reattachment of the meniscus posterior horn through a tibial ACL tunnel was equivalent to an anatomic fixation.

      Conclusions

      In the case of a root tear of the lateral meniscus, the MFL maintains meniscus function and stabilizes the pressure in the lateral compartment. A complete detachment of the posterior meniscus horn (MFL and root tear) leads to an increase in the intra-articular pressure. A root repair normalizes the pressure down to normal values. The tibial ACL tunnel is suitable to perform the repair and to lead out the suture.

      Clinical Relevance

      In the case of a complete detachment of the meniscus posterior horn, fixation of the posterior root is necessary to restore the meniscus function and to guarantee an equal pressure distribution in the lateral compartment. It can be combined with an ACL reconstruction.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Petersen W.
        • Tillmann B.
        Collagenous fibril texture of the human knee joint menisci.
        Anat Embryol (Berl). 1998; 197: 317-324
        • Yamamoto M.
        • Hirohata K.
        Anatomical study on the menisco-femoral ligaments of the knee.
        Kobe J Med Sci. 1991; 37: 209-226
        • Cho J.M.
        • Suh J.S.
        • Na J.B.
        • et al.
        Variations in meniscofemoral ligaments at anatomical study and MR imaging.
        Skeletal Radiol. 1999; 28: 189-195
        • Gupte C.M.
        • Smith A.
        • McDermott I.D.
        • Thomas R.D.
        • Bull A.M.J.
        • Amis A.A.
        Meniscofemoral ligaments revisited: Anatomical study, age correlation and clinical implications.
        J Bone Joint Surg Br. 2002; 84: 846-851
        • Gupte C.M.
        • Bull A.M.J.
        • Thomas R.D.
        • Amis A.A.
        The meniscofemoral ligaments: Secondary restraints to posterior drawer. Analysis of anteroposterior and rotatory laxity in the intact and posterior cruciate ligament-deficient knee.
        J Bone Joint Surg Br. 2003; 85: 765-773
        • Amadi H.O.
        • Gupte C.M.
        • Lie D.T.
        • McDermott I.D.
        • Amis A.A.
        • Bull A.M.
        A biomechanical study of the meniscofemoral ligaments and their contribution to contact pressure reduction in the knee.
        Knee Surg Sports Traumatol Arthrosc. 2008; 16: 1004-1008
        • Forkel P.
        • Petersen W.
        Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL double-bundle reconstruction: Technical note of a transosseous fixation using the tibial PL tunnel.
        Arch Orthop Trauma Surg. 2012; 132: 387-391
        • Forkel P.
        • Herbort M.
        • Schulze M.
        • et al.
        Biomechanical consequences of a posterior root tear of the lateral meniscus: Stabilizing effect of the meniscofemoral ligament.
        Arch Orthop Trauma Surg. 2013; 133: 621-626
        • Schillhammer C.K.
        • Werner F.W.
        • Scuderi M.G.
        • Cannizzaro J.P.
        Repair of lateral meniscus posterior horn detachment lesions: A biomechanical evaluation.
        Am J Sports Med. 2012; 40: 2604-2609
        • Bao H.R.
        • Zhu D.
        • Gong H.
        • Gu G.S.
        The effect of complete radial lateral meniscus posterior root tear on the knee contact mechanics: A finite element analysis.
        J Orthop Sci. 2013; 18: 256-263
        • Herbort M.
        • Zelle S.
        • Rosenbaum D.
        • et al.
        Arthroscopic fixation of matrix-associated autologous chondrocyte implantation: Importance of fixation pin angle on joint compression forces.
        Arthroscopy. 2011; 27: 809-816
        • Brody J.M.
        • Lin H.M.
        • Hulstyn M.J.
        • Tung G.A.
        Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear.
        Radiology. 2006; 239: 805-810
        • De Smet A.A.
        • Blankenbaker D.G.
        • Kijowski R.
        • Graf B.K.
        • Shinki K.
        MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard.
        AJR Am J Roentgenol. 2009; 192: 480-486
        • Petersen W.
        • Forkel P.
        • Achtnich A.
        • Metzlaff S.
        • Zantop T.
        Injuries of the anterior cruciate ligament: From prevention to therapy.
        OUP Orthop Unfallchir Praxis. 2012; 6: 232-243
        • West R.V.
        • Kim J.G.
        • Armfield D.
        • Harner C.D.
        Lateral meniscal root tears associated with anterior cruciate ligament injury: Classification and management (SS-70).
        Arthroscopy. 2004; 20 (abstr): e32-e33
        • Koenig J.H.
        • Ranawat A.S.
        • Umans H.R.
        • Difelice G.S.
        Meniscal root tears: Diagnosis and treatment.
        Arthroscopy. 2009; 25: 1025-1032
        • Shelbourne K.D.
        • Roberson T.A.
        • Gray T.
        Long-term evaluation of posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction.
        Am J Sports Med. 2011; 39: 1439-1443
        • Anderson L.
        • Watts M.
        • Shapter O.
        • et al.
        Repair of radial tears and posterior horn detachments of the lateral meniscus: Minimum 2-year follow-up.
        Arthroscopy. 2010; 26: 1625-1632
        • Ahn J.H.
        • Lee Y.S.
        • Yoo J.C.
        • Chang M.J.
        • Park S.J.
        • Pae Y.R.
        Results of arthroscopic all-inside repair for lateral meniscus root tear in patients undergoing concomitant anterior cruciate ligament reconstruction.
        Arthroscopy. 2010; 26: 67-75
        • Ahn J.H.
        • Lee Y.S.
        • Chang J.Y.
        • Chang M.J.
        • Eun S.S.
        • Kim S.M.
        Arthroscopic all inside repair of the lateral meniscus root tear.
        Knee. 2009; 16: 77-80
        • Petersen W.
        • Zantop T.
        Avulsion injury to the posterior horn of the lateral meniscus. Technique for arthroscopic refixation.
        Unfallchirurg. 2006; 109 (in German): 984-987
        • Stärke C.
        • Kopf S.
        • Gröbel K.H.
        • Becker R.
        The effect of a nonanatomic repair of the meniscal horn attachment on meniscal tension: A biomechanical study.
        Arthroscopy. 2010; 26: 358-365
        • Brody J.M.
        • Hulstyn M.J.
        • Fleming B.C.
        • Tung G.A.
        The meniscal roots: Gross anatomic correlation with 3-T MRI findings.
        AJR Am J Roentgenol. 2007; 188: W446-W450
        • Johannsen A.M.
        • Civitarese D.M.
        • Padalecki J.R.
        • Goldsmith M.T.
        • Wijdicks C.A.
        • LaPrade R.F.
        Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci.
        Am J Sports Med. 2012; 40: 2342-2347