Comparative Biomechanical Study on Contact Alterations After Lateral Meniscus Posterior Root Avulsion, Transosseous Reinsertion, and Total Meniscectomy.

PURPOSE To compare the effects of lateral meniscus posterior root avulsion left in situ, its repair, and meniscectomy on contact pressure distribution in both tibiofemoral compartments at different flexion angles. METHODS Eight cadaveric knees were tested under compressive 1000 N load for 4 lateral meniscus conditions (intact, posterior root avulsion, transosseous root repair, and total meniscectomy) at flexion angles 0°, 30°, 60°, and 90°. Contact area and pressure distribution were registered using K-scan pressure sensors inserted between menisci and tibial plateau. RESULTS In the lateral compartment, root detachment decreased contact area (P = .017, 0° and 30°; P = .012, 60° and 90°) and increased mean (P = .012, all angles) and maximum (P = .025, 0° and 30°; P = .017, 60°; P = .012, 90°) pressures relative to intact condition. Repair restored all measured parameters close to intact at 0°, but effectiveness decreased with flexion angle, yielding no significant effect at 90°. Meniscectomy produced higher decreases than root avulsion in contact area (P = .012, 0° and 90°; P = .05, 30° and 60°) and increases in mean (P = .017, 0° and 30°; P = .018, 90°) and maximum pressure (P = .012, 0°; P = .036, 30°). In the medial compartment, lesion changed the contact area at high flexion angles only, while meniscectomy induced greater changes at all angles. CONCLUSIONS Lateral meniscus posterior root avulsion generates significant alterations in contact area and pressures at lateral knee compartment for flexion angles between full extension and 90°. Meniscectomy causes greater disorders than the avulsion left in situ. Transosseous repair with a single suture restores these alterations to conditions close to intact at 0° and 30° but not at 60° and 90°. CLINICAL RELEVANCE Altered contact mechanics after lateral meniscus posterior root avulsion might have degenerative consequences. Transosseous repair with one suture should be revised to effectively restore contact mechanics at high flexion angles.

[1]  C. Harner,et al.  Lateral meniscal root tears associated with anterior cruciate ligament injury: classification and management (SS-70) , 2004 .

[2]  Guoan Li,et al.  Effect of repair of radial tears at the root of the posterior horn of the medial meniscus with the pullout suture technique: a biomechanical study using porcine knees. , 2009, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[3]  J. Park,et al.  Clinical, Radiological, and Morphological Evaluations of Posterior Horn Tears of the Lateral Meniscus Left In Situ During Anterior Cruciate Ligament Reconstruction , 2014, American Journal of Sports Medicine.

[4]  John J. Callaghan,et al.  The adult knee , 2003 .

[5]  R. LaPrade,et al.  Meniscal Root Tears , 2014, The American journal of sports medicine.

[6]  D. Rosenbaum,et al.  Biomechanical consequences of a posterior root tear of the lateral meniscus: stabilizing effect of the meniscofemoral ligament , 2013, Archives of Orthopaedic and Trauma Surgery.

[7]  A. Imhoff,et al.  Posterior root tear of the medial and lateral meniscus , 2014, Archives of Orthopaedic and Trauma Surgery.

[8]  J. Ahn,et al.  Results of arthroscopic all-inside repair for lateral meniscus root tear in patients undergoing concomitant anterior cruciate ligament reconstruction. , 2010, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[9]  K.,et al.  "Aggressive" Nontreatment of Lateral Meniscal Tears Seen During Anterior Cruciate Ligament Reconstruction , 1995, The American journal of sports medicine.

[10]  T. Bae,et al.  Tibiofemoral contact mechanics following posterior root of medial meniscus tear, repair, meniscectomy, and allograft transplantation , 2013, Knee Surgery, Sports Traumatology, Arthroscopy.

[11]  K. Shelbourne,et al.  Long-term Evaluation of Posterior Lateral Meniscus Root Tears Left In Situ at the Time of Anterior Cruciate Ligament Reconstruction , 2011, The American journal of sports medicine.

[12]  J. Marzo,et al.  Effects of Medial Meniscus Posterior Horn Avulsion and Repair on Tibiofemoral Contact Area and Peak Contact Pressure with Clinical Implications , 2009, The American journal of sports medicine.

[13]  A. Wilharm,et al.  Use of Tekscan K-Scan Sensors for Retropatellar Pressure Measurement Avoiding Errors during Implantation and the Effects of Shear Forces on the Measurement Precision , 2013, BioMed research international.

[14]  P. Noble,et al.  Effect of Lateral Meniscal Root Tear on the Stability of the Anterior Cruciate Ligament–Deficient Knee , 2015, The American journal of sports medicine.

[15]  D. Lerer,et al.  The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion , 2004, Skeletal Radiology.

[16]  A. Espejo-Baena,et al.  A simple device for inside-out meniscal suture. , 2004, Arthroscopy: The Journal of Arthroscopy And Related.

[17]  R. LaPrade,et al.  Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs. , 2014, The Journal of bone and joint surgery. American volume.

[18]  D. Wood,et al.  Medial meniscus posterior root attachment injury and degeneration: MRI findings. , 2006, Australasian radiology.

[19]  M. Brittberg,et al.  Evaluation of Cartilage Injuries and Repair , 2003, The Journal of bone and joint surgery. American volume.

[20]  Robert Allaire,et al.  Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. , 2008, The Journal of bone and joint surgery. American volume.

[21]  C. Harner,et al.  Changes in tibiofemoral contact mechanics following radial split and vertical tears of the medial meniscus an in vitro investigation of the efficacy of arthroscopic repair. , 2011, The Journal of bone and joint surgery. American volume.

[22]  C. Choi,et al.  Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. , 2010, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[23]  C. Kopuz,et al.  Anatomic and arthroscopic study of the medial meniscal horns’ insertions , 2010, Knee Surgery, Sports Traumatology, Arthroscopy.

[24]  J. Marzo,et al.  Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement. , 2011, The Knee.

[25]  M. Raschke,et al.  The biomechanical effect of a lateral meniscus posterior root tear with and without damage to the meniscofemoral ligament: efficacy of different repair techniques. , 2014, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[26]  W R Walsh,et al.  A novel method for measuring medial compartment pressures within the knee joint in-vivo. , 2003, Journal of biomechanics.

[27]  G. Tung,et al.  Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear. , 2006, Radiology.

[28]  F. Werner,et al.  Repair of Lateral Meniscus Posterior Horn Detachment Lesions , 2012, The American journal of sports medicine.

[29]  A. Amis,et al.  The effects of lateral meniscal allograft transplantation techniques on tibio-femoral contact pressures , 2008, Knee Surgery, Sports Traumatology, Arthroscopy.

[30]  Christof Hurschler,et al.  The effects of valgus medial opening wedge high tibial osteotomy on articular cartilage pressure of the knee: a biomechanical study. , 2007, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[31]  H. Gong,et al.  The effect of complete radial lateral meniscus posterior root tear on the knee contact mechanics: a finite element analysis , 2013, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[32]  T. Zantop,et al.  Root tear of the meniscus: biomechanical evaluation of an arthroscopic refixation technique , 2012, Archives of Orthopaedic and Trauma Surgery.

[33]  Brian J Cole,et al.  Effects of Serial Sectioning and Repair of Radial Tears in the Lateral Meniscus , 2012, The American journal of sports medicine.

[34]  T. Zantop,et al.  [Arthroscopic meniscal suture]. , 2006, Operative Orthopadie und Traumatologie.

[35]  Edgar Erdfelder,et al.  G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences , 2007, Behavior research methods.