2023 ISAKOS Biennial Congress ePoster
Concomitant Medial Meniscal Ramp Lesions and Lateral Meniscal Tears with Anterior Cruciate Ligament Injuries are Associated with Anterior Tibial Subluxation in Knee Extension
Hibiki Kakiage, MD, Maebashi, --お選びください-- JAPAN
Kazuhisa Hatayama, MD, PhD, Maebashi, Gunma JAPAN
Satoshi Nonaka, MD, Maebashi, Gunma JAPAN
Masanori Terauchi, MD, Gunma-Ken JAPAN
Atsufumi Oshima, MD, Maebashi JAPAN
HIrotaka Chikuda, MD, PhD, Maebashi, Gunma JAPAN
Department of Orthopedic Surgery, Japan Community Health Care Organization Gunma Central Hospital, Maebashi, Gunma, JAPAN
FDA Status Cleared
Summary
Preoperative anterior tibial subluxation is associated with medial and lateral meniscal tears and anterior knee stability.
ePosters will be available shortly before Congress
Abstract
?Background?
Anterior tibial subluxation (ATS) in knee extension is seen in anterior cruciate ligament (ACL) injured knees. It has been reported that preoperative ATS adversely affects postoperative anterior and rotation stability and risks early graft failure. The purpose of this study was to investigate the associated factors with preoperative ATS in ACL injured knees.
?Methods?
A total of 99 patients who underwent primary ACL reconstruction at our hospital were included (51 females, 48 males, mean age 29.9 years old, range 14 to 62). Patients with ACL injury of the contralateral knee were excluded. Preoperatively, all patients were taken lateral radiographs in full extension of both knees to evaluate ATS. ATS was measured the distance between a perpendicular line to femoral condyles and tibial condyles with respect to the medial tibial plateau to one decimal place. Patients with a side-to-side difference (SSD) of 2 mm or more were placed in ATS positive group. We investigated whether age, height, weight, gender, time from injury to surgery, posterior tibia slope(PTS) and hyperextension angle from lateral radiographs in knee extension, SSD in anterior tibial translation using Telos Stress device at 20 degrees, meniscal tear, mechanism of injury were related to ATS or not. The student t test and the chi-square test were used to compare the two groups. P values <.05 were considered significant. All statical analyses were performed using SPSS software.
?Results?
The mean ATS was 1.7 ± 1.8 (-1.8 to 8.4 mm). There were 36 patients in the ATS positive group and 63 in the ATS negative group. ATS positive group had significantly greater SSD in anterior tibial translation (8.5 ± 3.9 vs 6.1 ± 3.4 mm, p=0.003). There were no significant differences in age, height, weight, gender, time from injury to surgery, PTS and hyperextension angle, mechanics of injury between the two groups.
The ATS in ACL injured knees with medial meniscal ramp lesion (n=32) was significantly greater than that in the knees without meniscal tear (n=33) (2.2 ± 2.1 vs 1.0 ± 1.6 mm, p=0.014). Also, the ATS ACL injured knees with lateral meniscal tear (n=43) was significantly greater than that in the knees without meniscal tears (n=33) (2.0 ± 1.9 vs 1.0 ± 1.6mm, p=0.02).
?Discussion?
Present study showed that ATS positive group had greater anterior knee laxity than the ATS negative group. And ATS in ACL injured knees with ramp lesion or lateral meniscal tear was significantly greater than that in the knee without meniscal tear. Preoperative ATS was associates with not only ACL deficiency but also secondary restraint injuries such as ramp lesions and lateral meniscal tears. Clinically, it may be important to perform appropriate meniscal repair at the time of ACL reconstruction to avoid causing increased forces in the ACL graft and reduce postoperative ATS after ACL reconstruction.