Purpose
To quantify the effects that posterior meniscofemoral ligament (pMFL) lesions have
on lateral meniscal extrusion (ME) both with and without concomitant posterior lateral
meniscal root (PLMR) tears and describe how lateral ME varied along the length of
the lateral meniscus.
Methods
Ultrasonography was used to measure ME of human cadaveric knees (n = 10) under the
following conditions: control, isolated pMFL sectioning, isolated PLMR sectioning,
pMFL+PLMR sectioning, and PLMR repair. ME was measured anterior to the fibular collateral
ligament (FCL), at the FCL, and posterior to the FCL in both unloaded and axially
loaded states at 0° and 30° of flexion.
Results
Isolated and combined pMFL and PLMR sectioning consistently demonstrated significantly
greater ME when measured posterior to the FCL compared with other image locations.
Isolated pMFL tears demonstrated greater ME at 0° compared with 30° of flexion (P < .05), whereas isolated PLMR tears demonstrated greater ME at 30° compared with
0° of flexion (P < .001). All specimens with isolated PLMR deficiencies demonstrated greater than
2 mm of ME at 30° flexion, whereas only 20% of specimens did so at 0°. When the pMFL
was sectioned following an isolated PLMR tear, there was a significant increase in
ME at 0° (P < .001). PLMR repair after combined sectioning restored ME to levels similar to that
of controls in all specimens when measured at and posterior to the FCL (P < .001).
Conclusions
The pMFL protects against ME primarily in full extension, whereas the presence of
ME in the setting of PLMR injuries may be better appreciated in knee flexion. With
combined tears, isolated repair of the PLMR can restore near-native meniscus position.
Clinical Relevance
The stabilizing properties of intact pMFL may mask the presentation of PLMR tears
and delay appropriate management. Additionally, the MFL is not routinely assessed
during arthroscopy due to difficult visualization and access. Understanding the ME
pattern of these pathologies in isolation and combination may improve detection rates
so that the source of patients’ symptoms can be addressed to satisfaction.
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 accessOne-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 ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Late degenerative changes after meniscectomy. Factors affecting the knee after operation.J Bone Joint Surg Br. 1984; 66: 666-671
- Knee joint changes after meniscectomy.J Bone Joint Surg Br. 1948; 30B: 664-670
- The basic science of human knee menisci: Structure, composition, and function.Sports Health. 2012; 4: 340-351
- The biomechanical effect of a lateral meniscus posterior root tear with and without damage to the meniscofemoral ligament: Efficacy of different repair techniques.Arthroscopy. 2014; 30: 833-840
- A review of the function and biomechanics of the meniscofemoral ligaments.Arthroscopy. 2003; 19: 161-171
- Anatomical study on the menisco-femoral ligaments of the knee.Kobe J Med Sci. 1991; 37: 209-226
- 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
- Factors affecting the region of most isometric femoral attachments. Part I: The posterior cruciate ligament.Am J Sports Med. 1989; 17: 197-207
- Analysis of meniscofemoral ligament tension during knee motion.Arthroscopy. 2006; 22: 362-366
- Influence of lateral meniscal posterior root avulsions and the meniscofemoral ligaments on tibiofemoral contact mechanics.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1469-1477
- Medial versus lateral meniscus root tears: Is there a difference in injury presentation, treatment decisions, and surgical repair outcomes?.Arthroscopy. 2020; 36: 1135-1141
- Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear.Radiology. 2006; 239: 805-810
- Are root avulsions of the lateral meniscus associated with extrusion at the time of acute anterior cruciate ligament injury? A case control study.Am J Sports Med. 2014; 42: 173-176
- Ultrasound of the knee.Skelet Radiol. 2001; 30: 361-377
- No dynamic extrusion of the medial meniscus in ultrasound examination in patients with confirmed root tear lesion.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 3311-3317
- The value of ultrasonography in the detection of meniscal tears diagnosed by magnetic resonance imaging.Am J Phys Med Rehabil. 2008; 87: 14-20
- Evaluation of meniscal extrusion with posterior root disruption and repair using ultrasound.Knee. 2016; 23: 627-630
- Ultrasound assessment of medial meniscal extrusion: A validation study using MRI as reference standard.AJR Am J Roentgenol. 2015; 204: 584-588
- Correlation between medial meniscal extrusion determined by dynamic ultrasound and magnetic resonance imaging findings of medial-type knee osteoarthritis in patients with knee pain.J Ultrasound Med. 2019; 38: 2709-2719
- Biomechanical evaluation of a high tibial osteotomy with a meniscal transplant.J Knee Surg. 2011; 24: 45-54
- Concomitant meniscotibial ligament reconstruction decreases meniscal extrusion following medial meniscus allograft transplantation: A cadaveric analysis.Arthroscopy. 2022; 38: 3080-3089
- Surgical treatment of meniscal extrusion: A biomechanical study on the role of the medial meniscotibial ligaments with early clinical validation.Orthop J Sports Med. 2020; 8232596712093667
- Utilization of transtibial centralization suture best minimizes extrusion and restores tibiofemoral contact mechanics for anatomic medial meniscal root repairs in a cadaveric model.Am J Sports Med. 2019; 47: 1591-1600
- Posterior meniscal root repair: the transtibial double tunnel pullout technique.Arthrosc Tech. 2016; 5: e291-e296
- The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion.Skeletal Radiol. 2004; 33
- Doppler perfusion index: An interobserver and intraobserver reproducibility study.Radiology. 1998; 208: 453-457
- MSK Imaging Tips and Tricks. MAGNETOM Flash.http://clinical-mri.com/wp-content/uploads/new_technologies/MSK_MRI_Tips_and_Tricks_Mark_Lourensz_Flash50.pdf(Published February 1, 2012)Date accessed: January 1, 2022
- Power, effect and sample size using GPower: Practical issues for researchers and members of research ethics committees.Evidence Based Midwifery. 2007; 5: 132-136
- G∗Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.Behav Res Methods. 2007; 39: 175-191
- 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
- Scrutinizing the cut-off for “pathological” meniscal body extrusion on knee MRI.Eur Radiol. 2019; 29: 2616-2623
- Determining a threshold of medial meniscal extrusion for prediction of knee pain and cartilage damage progression over 4 years: Data from the Osteoarthritis Initiative.AJR Am J Roentgenol. 2021; 216: 1318-1328
- Meniscal extrusion in the knee: should only 3 mm extrusion be considered significant? An assessment by MRI and arthroscopy.Malays Orthop J. 2015; 9: 17-20
- Cut-off value of medial meniscal extrusion for knee pain.Adv Orthop. 2017; 20176793026
- Factors associated with meniscal extrusion in knees with or at risk for osteoarthritis: The Multicenter Osteoarthritis Study.Radiology. 2012; 264: 494-503
- Dynamic ultrasound assessment of medial meniscal subluxation in knee osteoarthritis.Rheumatology. 2013; 52: 1443-1447
- Medial meniscus extrusion increases with age and BMI and is depending on different loading conditions.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2282-2288
Article info
Publication history
Published online: February 20, 2023
Accepted:
February 2,
2023
Received:
July 5,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
This work was supported by the Arthrex. The authors report the following potential conflicts of interest or sources of funding: D.M.K. reports other from Arthrex, personal fees from DJ Orthopaedics, and other from Encore Medical and Smith & Nephew, outside the submitted work. M.H. reports personal fees from Moximed, outside the submitted work; and Journal of Cartilage and Joint Preservation: editorial or governing board. J.C. reports other from Arthrex, CONMED Linvatec, Ossur, and Smith & Nephew, outside the submitted work; and American Orthopaedic Society for Sports Medicine: board or committee member; Arthroscopy Association of North America: board or committee member; and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: board or committee member. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Associated abstract presented at the AANA 2022 Meeting, May 19-21, 2022, San Francisco, California, U.S.A.
Identification
Copyright
© 2023 by the Arthroscopy Association of North America
