Research Article|Articles in Press

Quantifying Meniscal Extrusion Using Ultrasound in the Setting of Concomitant Cadaveric Knee Lesions: Part I: The Medial Meniscotibial Ligament and Posterior Medial Meniscal Root

Published:February 20, 2023DOI:



      1. Evaluate how the meniscotibial ligament (MTL) affects meniscal extrusion (ME) +/- concomitant posterior medial meniscal root (PMMR) tears. 2. Describe how ME varied along length of meniscus.


      ME was measured using ultrasonography in 10 human cadaveric knees in conditions: (1) control, either (2a) isolated MTL sectioning, or (2b) isolated PMMR tear, (3) combined PMMR + MTL sectioning, and (4) PMMR repair. Measurements were obtained 1 cm anterior to the MCL (anterior), over the MCL (middle), and 1 cm posterior to the MCL (posterior) +/- 1000N axial loads in 0° and 30° flexion.


      At 0°, MTL sectioning demonstrated greater middle than anterior (P<0.001) and posterior (P<0.001) ME, while PMMR (P=0.0042) and PMMR+MTL (P<0.001) sectioning demonstrated greater posterior than anterior ME. At 30°, PMMR (P<0.001) and PMMR+MTL (P<0.001) sectioning demonstrated greater posterior than anterior ME, and PMMR (P=0.0012) and PMMR+MTL (P=0.0058) sectioning demonstrated greater posterior than anterior ME. PMMR+MTL sectioning demonstrated greater posterior ME at 30° compared to 0° (P=0.0320). MTL sectioning always resulted in greater middle ME (P<0.001), in contrast with no middle ME changes following PMMR sectioning. At 0°, PMMR sectioning resulted in greater posterior ME (P<0.001), but at 30°, both PMMR and MTL sectioning resulted in greater posterior ME (P<0.001). Total ME surpassed 3 mm only when both the MTL and PMMR were sectioned.


      The MTL and PMMR contribute most to ME when measured posterior to the MCL at 30° of flexion. ME greater than 3 mm is suggestive of combined PMMR + MTL lesions.

      Clinical Relevance

      Overlooked MTL pathology may contribute to persistent ME following PMMR repair. We found isolated MTL tears able to cause 2-2.99 mm of ME, but the clinical significance of these magnitudes of extrusion is unclear. The use of ME measurement guidelines with ultrasound may allow for practical MTL and PMMR pathology screening and pre-operative planning.
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