Abstract:
Purpose
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.
Methods
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.
Results
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.
Conclusion
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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Article info
Publication history
Accepted:
January 8,
2023
Received in revised form:
January 5,
2023
Received:
July 5,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Contribution of each author using ICJME criteria
Legend
1 – Substantial contributions to the conception or design of the work, acquisition, analysis, and interpretation of data for the work.
2 - Drafting of the work and revising it critically for important intellectual content
3 – Final approval of the version to be published
4 – Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved
DF – 1,2,3,4
DMK – 1,2,3,4
ASV – 1,2,3,4
NBC – 1,2,3,4
MH – 1,2,3,4
EFS – 1,2,3,4
MR – 1,2,3,4
GMW – 1,2,3,4
JC – 1,2,3,4
Conflicts of interest and source of funding: The authors received no financial support for the research, authorship, and/or publication of this article. The authors have no conflicts of interest with respect to the authorship and/or publication of this article.
Associated Abstract Presented at AANA 2022 Meeting
Medial Meniscal Extrusion of greater than 3 mm on Ultrasound Suggests Combined Medial Meniscotibial Ligament and Posterior Medial Meniscal Root Tears: A Cadaveric Analysis
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