Effect of Lateral Meniscal Root Tear on the Stability of the Anterior Cruciate Ligament–Deficient Knee
Background: Meniscal root tears are an increasingly recognized subset of meniscal injury. The menisci are critical secondary stabilizers of the anterior cruciate ligament (ACL). The kinematic effect of lateral meniscus posterior root tear in the setting of ACL injury is not known. Purpose/Hypothesis...
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| Veröffentlicht in: | The American journal of sports medicine 2015-04, Vol.43 (4), p.905-911 |
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| creator | Shybut, Theodore B. Vega, Charles E. Haddad, Jebran Alexander, Jerry W. Gold, Jonathon E. Noble, Philip C. Lowe, Walter R. |
| description | Background:
Meniscal root tears are an increasingly recognized subset of meniscal injury. The menisci are critical secondary stabilizers of the anterior cruciate ligament (ACL). The kinematic effect of lateral meniscus posterior root tear in the setting of ACL injury is not known.
Purpose/Hypothesis:
The purpose of this study was to determine the effect of tear of the lateral meniscal root on stability of the ACL-deficient knee. The hypothesis was that disruption of the lateral meniscal root will further destabilize the ACL-deficient knee during a simulated pivot shift.
Study Design:
Controlled laboratory study.
Methods:
Pivot-shift testing of 8 fresh-frozen cadaveric knees was performed after attachment of photoreflective flags and preparation of CT scans. Each knee was mounted in a custom activity simulator and dynamically loaded from 15° to 90° of flexion with all the permutations of the following: iliotibial band force (50, 75, 100, 125, 150, and 175 N), internal rotation moments (1, 2, and 3 N·m), and valgus moments (5 and 7 N·m). In addition, anterior stability tests were performed by applying a 90-N anterior force to the tibia at flexion angles of 15°, 30°, 45°, 60°, and 90°. During each test, the anterior tibial translation and rotation of the tibia were measured with a high-resolution multiple infrared camera motion analysis system for the following 3 conditions: ACL-intact (ACL-I), ACL-deficient (ACL-D), and ACL-deficient/lateral meniscal posterior root avulsion (ACL-D/LMR-A).
Results:
A pivot-shift phenomenon was observed in the ACL-D and ACL-D/LMR-A conditions. The mean tibial translation of the lateral tibial condyle during the pivot-shift maneuver was 2.62 ± 0.53 mm for the ACL-I knees, 6.01 ± 0.51 mm for the ACL-D knees (P value vs intact: .0005), and 8.13 ± 0.75 mm for the ACL-D/LMR-A knees (P value vs intact: |
| doi_str_mv | 10.1177/0363546514563910 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1669452803</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0363546514563910</sage_id><sourcerecordid>1933400161</sourcerecordid><originalsourceid>FETCH-LOGICAL-c431t-d2b1d18f8ea613cb0e39b005c933b20f8678d26d58aaa1baa6f3f651dac3815c3</originalsourceid><addsrcrecordid>eNp1kctKxDAUhoMoOo7uXUnAjZtq0jSZdCnjFUcEHdclTU_GSKfRJF248x18Q5_ElFERwVUOOd__nxtCe5QcUTqZHBMmGC8EpwUXrKRkDY0o53nGmODraDSksyG_hbZDeCKE0ImQm2gr51yWTIoRejwzBnTEzuCZiuBVi2-gs0Gn4M65iOegPHYdjo-A76OqbWvj64APHyddkljn8dT32iY9ntmFWkIXP97eT8FYbVOMrzuAHbRhVBtg9-sdo4fzs_n0MpvdXlxNT2aZLhiNWZPXtKHSSFCCMl0TYGVNCNclY3VOjBQT2eSi4VIpRWulhGEmLaBRmknKNRujw5Xvs3cvPYRYLdM00LaqA9eHigpRFjyXhCX04A_65Hrfpe4qmsoVaV2phzEiK0p7F4IHUz17u1T-taKkGq5Q_b1Ckux_Gff1EpofwffaE5CtgKAW8Kvqf4af-CaO1g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1933400161</pqid></control><display><type>article</type><title>Effect of Lateral Meniscal Root Tear on the Stability of the Anterior Cruciate Ligament–Deficient Knee</title><source>SAGE Complete A-Z List</source><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Shybut, Theodore B. ; Vega, Charles E. ; Haddad, Jebran ; Alexander, Jerry W. ; Gold, Jonathon E. ; Noble, Philip C. ; Lowe, Walter R.</creator><creatorcontrib>Shybut, Theodore B. ; Vega, Charles E. ; Haddad, Jebran ; Alexander, Jerry W. ; Gold, Jonathon E. ; Noble, Philip C. ; Lowe, Walter R.</creatorcontrib><description>Background:
Meniscal root tears are an increasingly recognized subset of meniscal injury. The menisci are critical secondary stabilizers of the anterior cruciate ligament (ACL). The kinematic effect of lateral meniscus posterior root tear in the setting of ACL injury is not known.
Purpose/Hypothesis:
The purpose of this study was to determine the effect of tear of the lateral meniscal root on stability of the ACL-deficient knee. The hypothesis was that disruption of the lateral meniscal root will further destabilize the ACL-deficient knee during a simulated pivot shift.
Study Design:
Controlled laboratory study.
Methods:
Pivot-shift testing of 8 fresh-frozen cadaveric knees was performed after attachment of photoreflective flags and preparation of CT scans. Each knee was mounted in a custom activity simulator and dynamically loaded from 15° to 90° of flexion with all the permutations of the following: iliotibial band force (50, 75, 100, 125, 150, and 175 N), internal rotation moments (1, 2, and 3 N·m), and valgus moments (5 and 7 N·m). In addition, anterior stability tests were performed by applying a 90-N anterior force to the tibia at flexion angles of 15°, 30°, 45°, 60°, and 90°. During each test, the anterior tibial translation and rotation of the tibia were measured with a high-resolution multiple infrared camera motion analysis system for the following 3 conditions: ACL-intact (ACL-I), ACL-deficient (ACL-D), and ACL-deficient/lateral meniscal posterior root avulsion (ACL-D/LMR-A).
Results:
A pivot-shift phenomenon was observed in the ACL-D and ACL-D/LMR-A conditions. The mean tibial translation of the lateral tibial condyle during the pivot-shift maneuver was 2.62 ± 0.53 mm for the ACL-I knees, 6.01 ± 0.51 mm for the ACL-D knees (P value vs intact: .0005), and 8.13 ± 0.75 mm for the ACL-D/LMR-A knees (P value vs intact: <.0001). During the pivot-shift maneuver, translation was significantly increased in the ACL-D/LMR-A condition compared with the ACL-D condition (P = .0146). Compared with the intact group, anterior tibial translation during the Lachman maneuver also increased at 30° and 90° of flexion in the ACL-D group (P < .0001) and the ACL-D/LM group (P < .0001). No statistically significant difference was found between the ACL-D and ACL-D/LMR-A groups during the Lachman maneuver at 30° and 90° (P = .16 and .72, respectively).
Conclusion:
A tear of the lateral meniscal posterior root further reduces the stability of the ACL-deficient knee during rotational loading.
Clinical Relevance:
This study shows that lateral meniscal root injury further destabilizes the ACL-deficient knee and thus advances the concept that the lateral meniscus is a secondary stabilizer of the knee under pivot-shift loading. In the absence of stronger evidence, the study data suggest a rationale for surgical repair of lateral meniscal root tears encountered in the setting of ACL tears.</description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/0363546514563910</identifier><identifier>PMID: 25589386</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adult ; Anterior Cruciate Ligament - physiopathology ; Anterior Cruciate Ligament Injuries ; Biomechanical Phenomena ; Cadaver ; Female ; Humans ; Hypotheses ; Joint Instability - physiopathology ; Knee ; Knee Injuries - physiopathology ; Knee Joint - physiopathology ; Male ; Middle Aged ; Range of Motion, Articular ; Rotation ; Skin & tissue grafts ; Sports medicine ; Tibia - pathology ; Tibial Meniscus Injuries ; Tomography, X-Ray Computed</subject><ispartof>The American journal of sports medicine, 2015-04, Vol.43 (4), p.905-911</ispartof><rights>2015 The Author(s)</rights><rights>2015 The Author(s).</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c431t-d2b1d18f8ea613cb0e39b005c933b20f8678d26d58aaa1baa6f3f651dac3815c3</citedby><cites>FETCH-LOGICAL-c431t-d2b1d18f8ea613cb0e39b005c933b20f8678d26d58aaa1baa6f3f651dac3815c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0363546514563910$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0363546514563910$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25589386$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shybut, Theodore B.</creatorcontrib><creatorcontrib>Vega, Charles E.</creatorcontrib><creatorcontrib>Haddad, Jebran</creatorcontrib><creatorcontrib>Alexander, Jerry W.</creatorcontrib><creatorcontrib>Gold, Jonathon E.</creatorcontrib><creatorcontrib>Noble, Philip C.</creatorcontrib><creatorcontrib>Lowe, Walter R.</creatorcontrib><title>Effect of Lateral Meniscal Root Tear on the Stability of the Anterior Cruciate Ligament–Deficient Knee</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description>Background:
Meniscal root tears are an increasingly recognized subset of meniscal injury. The menisci are critical secondary stabilizers of the anterior cruciate ligament (ACL). The kinematic effect of lateral meniscus posterior root tear in the setting of ACL injury is not known.
Purpose/Hypothesis:
The purpose of this study was to determine the effect of tear of the lateral meniscal root on stability of the ACL-deficient knee. The hypothesis was that disruption of the lateral meniscal root will further destabilize the ACL-deficient knee during a simulated pivot shift.
Study Design:
Controlled laboratory study.
Methods:
Pivot-shift testing of 8 fresh-frozen cadaveric knees was performed after attachment of photoreflective flags and preparation of CT scans. Each knee was mounted in a custom activity simulator and dynamically loaded from 15° to 90° of flexion with all the permutations of the following: iliotibial band force (50, 75, 100, 125, 150, and 175 N), internal rotation moments (1, 2, and 3 N·m), and valgus moments (5 and 7 N·m). In addition, anterior stability tests were performed by applying a 90-N anterior force to the tibia at flexion angles of 15°, 30°, 45°, 60°, and 90°. During each test, the anterior tibial translation and rotation of the tibia were measured with a high-resolution multiple infrared camera motion analysis system for the following 3 conditions: ACL-intact (ACL-I), ACL-deficient (ACL-D), and ACL-deficient/lateral meniscal posterior root avulsion (ACL-D/LMR-A).
Results:
A pivot-shift phenomenon was observed in the ACL-D and ACL-D/LMR-A conditions. The mean tibial translation of the lateral tibial condyle during the pivot-shift maneuver was 2.62 ± 0.53 mm for the ACL-I knees, 6.01 ± 0.51 mm for the ACL-D knees (P value vs intact: .0005), and 8.13 ± 0.75 mm for the ACL-D/LMR-A knees (P value vs intact: <.0001). During the pivot-shift maneuver, translation was significantly increased in the ACL-D/LMR-A condition compared with the ACL-D condition (P = .0146). Compared with the intact group, anterior tibial translation during the Lachman maneuver also increased at 30° and 90° of flexion in the ACL-D group (P < .0001) and the ACL-D/LM group (P < .0001). No statistically significant difference was found between the ACL-D and ACL-D/LMR-A groups during the Lachman maneuver at 30° and 90° (P = .16 and .72, respectively).
Conclusion:
A tear of the lateral meniscal posterior root further reduces the stability of the ACL-deficient knee during rotational loading.
Clinical Relevance:
This study shows that lateral meniscal root injury further destabilizes the ACL-deficient knee and thus advances the concept that the lateral meniscus is a secondary stabilizer of the knee under pivot-shift loading. In the absence of stronger evidence, the study data suggest a rationale for surgical repair of lateral meniscal root tears encountered in the setting of ACL tears.</description><subject>Adult</subject><subject>Anterior Cruciate Ligament - physiopathology</subject><subject>Anterior Cruciate Ligament Injuries</subject><subject>Biomechanical Phenomena</subject><subject>Cadaver</subject><subject>Female</subject><subject>Humans</subject><subject>Hypotheses</subject><subject>Joint Instability - physiopathology</subject><subject>Knee</subject><subject>Knee Injuries - physiopathology</subject><subject>Knee Joint - physiopathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Range of Motion, Articular</subject><subject>Rotation</subject><subject>Skin & tissue grafts</subject><subject>Sports medicine</subject><subject>Tibia - pathology</subject><subject>Tibial Meniscus Injuries</subject><subject>Tomography, X-Ray Computed</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kctKxDAUhoMoOo7uXUnAjZtq0jSZdCnjFUcEHdclTU_GSKfRJF248x18Q5_ElFERwVUOOd__nxtCe5QcUTqZHBMmGC8EpwUXrKRkDY0o53nGmODraDSksyG_hbZDeCKE0ImQm2gr51yWTIoRejwzBnTEzuCZiuBVi2-gs0Gn4M65iOegPHYdjo-A76OqbWvj64APHyddkljn8dT32iY9ntmFWkIXP97eT8FYbVOMrzuAHbRhVBtg9-sdo4fzs_n0MpvdXlxNT2aZLhiNWZPXtKHSSFCCMl0TYGVNCNclY3VOjBQT2eSi4VIpRWulhGEmLaBRmknKNRujw5Xvs3cvPYRYLdM00LaqA9eHigpRFjyXhCX04A_65Hrfpe4qmsoVaV2phzEiK0p7F4IHUz17u1T-taKkGq5Q_b1Ckux_Gff1EpofwffaE5CtgKAW8Kvqf4af-CaO1g</recordid><startdate>20150401</startdate><enddate>20150401</enddate><creator>Shybut, Theodore B.</creator><creator>Vega, Charles E.</creator><creator>Haddad, Jebran</creator><creator>Alexander, Jerry W.</creator><creator>Gold, Jonathon E.</creator><creator>Noble, Philip C.</creator><creator>Lowe, Walter R.</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20150401</creationdate><title>Effect of Lateral Meniscal Root Tear on the Stability of the Anterior Cruciate Ligament–Deficient Knee</title><author>Shybut, Theodore B. ; Vega, Charles E. ; Haddad, Jebran ; Alexander, Jerry W. ; Gold, Jonathon E. ; Noble, Philip C. ; Lowe, Walter R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c431t-d2b1d18f8ea613cb0e39b005c933b20f8678d26d58aaa1baa6f3f651dac3815c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Anterior Cruciate Ligament - physiopathology</topic><topic>Anterior Cruciate Ligament Injuries</topic><topic>Biomechanical Phenomena</topic><topic>Cadaver</topic><topic>Female</topic><topic>Humans</topic><topic>Hypotheses</topic><topic>Joint Instability - physiopathology</topic><topic>Knee</topic><topic>Knee Injuries - physiopathology</topic><topic>Knee Joint - physiopathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Range of Motion, Articular</topic><topic>Rotation</topic><topic>Skin & tissue grafts</topic><topic>Sports medicine</topic><topic>Tibia - pathology</topic><topic>Tibial Meniscus Injuries</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shybut, Theodore B.</creatorcontrib><creatorcontrib>Vega, Charles E.</creatorcontrib><creatorcontrib>Haddad, Jebran</creatorcontrib><creatorcontrib>Alexander, Jerry W.</creatorcontrib><creatorcontrib>Gold, Jonathon E.</creatorcontrib><creatorcontrib>Noble, Philip C.</creatorcontrib><creatorcontrib>Lowe, Walter R.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shybut, Theodore B.</au><au>Vega, Charles E.</au><au>Haddad, Jebran</au><au>Alexander, Jerry W.</au><au>Gold, Jonathon E.</au><au>Noble, Philip C.</au><au>Lowe, Walter R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Lateral Meniscal Root Tear on the Stability of the Anterior Cruciate Ligament–Deficient Knee</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2015-04-01</date><risdate>2015</risdate><volume>43</volume><issue>4</issue><spage>905</spage><epage>911</epage><pages>905-911</pages><issn>0363-5465</issn><eissn>1552-3365</eissn><abstract>Background:
Meniscal root tears are an increasingly recognized subset of meniscal injury. The menisci are critical secondary stabilizers of the anterior cruciate ligament (ACL). The kinematic effect of lateral meniscus posterior root tear in the setting of ACL injury is not known.
Purpose/Hypothesis:
The purpose of this study was to determine the effect of tear of the lateral meniscal root on stability of the ACL-deficient knee. The hypothesis was that disruption of the lateral meniscal root will further destabilize the ACL-deficient knee during a simulated pivot shift.
Study Design:
Controlled laboratory study.
Methods:
Pivot-shift testing of 8 fresh-frozen cadaveric knees was performed after attachment of photoreflective flags and preparation of CT scans. Each knee was mounted in a custom activity simulator and dynamically loaded from 15° to 90° of flexion with all the permutations of the following: iliotibial band force (50, 75, 100, 125, 150, and 175 N), internal rotation moments (1, 2, and 3 N·m), and valgus moments (5 and 7 N·m). In addition, anterior stability tests were performed by applying a 90-N anterior force to the tibia at flexion angles of 15°, 30°, 45°, 60°, and 90°. During each test, the anterior tibial translation and rotation of the tibia were measured with a high-resolution multiple infrared camera motion analysis system for the following 3 conditions: ACL-intact (ACL-I), ACL-deficient (ACL-D), and ACL-deficient/lateral meniscal posterior root avulsion (ACL-D/LMR-A).
Results:
A pivot-shift phenomenon was observed in the ACL-D and ACL-D/LMR-A conditions. The mean tibial translation of the lateral tibial condyle during the pivot-shift maneuver was 2.62 ± 0.53 mm for the ACL-I knees, 6.01 ± 0.51 mm for the ACL-D knees (P value vs intact: .0005), and 8.13 ± 0.75 mm for the ACL-D/LMR-A knees (P value vs intact: <.0001). During the pivot-shift maneuver, translation was significantly increased in the ACL-D/LMR-A condition compared with the ACL-D condition (P = .0146). Compared with the intact group, anterior tibial translation during the Lachman maneuver also increased at 30° and 90° of flexion in the ACL-D group (P < .0001) and the ACL-D/LM group (P < .0001). No statistically significant difference was found between the ACL-D and ACL-D/LMR-A groups during the Lachman maneuver at 30° and 90° (P = .16 and .72, respectively).
Conclusion:
A tear of the lateral meniscal posterior root further reduces the stability of the ACL-deficient knee during rotational loading.
Clinical Relevance:
This study shows that lateral meniscal root injury further destabilizes the ACL-deficient knee and thus advances the concept that the lateral meniscus is a secondary stabilizer of the knee under pivot-shift loading. In the absence of stronger evidence, the study data suggest a rationale for surgical repair of lateral meniscal root tears encountered in the setting of ACL tears.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>25589386</pmid><doi>10.1177/0363546514563910</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0363-5465 |
| ispartof | The American journal of sports medicine, 2015-04, Vol.43 (4), p.905-911 |
| issn | 0363-5465 1552-3365 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1669452803 |
| source | SAGE Complete A-Z List; MEDLINE; Alma/SFX Local Collection |
| subjects | Adult Anterior Cruciate Ligament - physiopathology Anterior Cruciate Ligament Injuries Biomechanical Phenomena Cadaver Female Humans Hypotheses Joint Instability - physiopathology Knee Knee Injuries - physiopathology Knee Joint - physiopathology Male Middle Aged Range of Motion, Articular Rotation Skin & tissue grafts Sports medicine Tibia - pathology Tibial Meniscus Injuries Tomography, X-Ray Computed |
| title | Effect of Lateral Meniscal Root Tear on the Stability of the Anterior Cruciate Ligament–Deficient Knee |
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