Search Filters

  • Presentation Format
  • Media Type
  • Diagnosis / Condition
  • Diagnosis Method
  • Patient Populations
  • Treatment / Technique

The Effect of Lateral Extra-Articular Tenodesis on Medial and Lateral Menisci Loading in Response To Simulated Tests of the Pivot Shift and Anterior Laxity

The Effect of Lateral Extra-Articular Tenodesis on Medial and Lateral Menisci Loading in Response To Simulated Tests of the Pivot Shift and Anterior Laxity

Niv Marom, MD, ISRAEL Hamid Jahandar, BS, UNITED STATES Zaid Zayyad, MD, MS, UNITED STATES thomas fraychineaud, MD, UNITED STATES Herve Ouanezar, MD, UNITED ARAB EMIRATES Ronak M. Patel, MD, UNITED STATES Carl W Imhauser, PhD, UNITED STATES Thomas L. Wickiewicz, MD, UNITED STATES Andrew D. Pearle, MD, UNITED STATES Danyal H. Nawabi, MD, FRCS(Orth), UNITED STATES

Hospital for Special Surgery, New York, UNITED STATES


2021 Congress   Abstract Presentation   6 minutes   rating (1)

 

Anatomic Location

Anatomic Structure

Diagnosis / Condition

Treatment / Technique

Sports Medicine

This media is available to current ISAKOS Members, Global Link All-Access Subscribers and Webinar/Course Registrants only.

Summary: ACLR in isolation is an effective strategy to normalize the increased loads on both menisci with ACL deficiency during pivoting and anterior laxity tests. LET augmentation to ACLR may increase lateral meniscal load in flexion, which may affect outcomes in cases of concomitant lateral meniscal pathology


Background

The biomechanical impact of lateral extra-articular tenodesis (LET) performed in conjunction with anterior cruciate ligament reconstruction (ACLR) on loads carried by the knee menisci is not clear. Alterations in menisci loading may affect meniscal integrity and healing potential when injured.

Purpose

To quantify forces carried by the lateral and medial menisci in response to simulated tests of the pivot shift and anterior laxity in various knee conditions including the intact ACL knee, sectioned ACL knee, ACLR knee and ACLR augmented with LET.

Methods

Eight cadaveric knees (mean age: 34.8±11.7; 4 male) were mounted to a robotic manipulator. The robot simulated two types of pivoting maneuvers and tests of anterior laxity; namely, the Lachman and anterior drawer. Each knee was assessed in the following states: ACL intact, ACL sectioned, ACL reconstructed (using a bone-patellar tendon-bone autograft), and finally, after performing LET (a modified Lemaire technique, after sectioning the anterolateral ligament (ALL) and Kaplan fibers). Resultant forces carried by the medial and lateral menisci at the peak applied loads were determined via superposition.

Results

Compared to the intact knee, sectioning the ACL increased lateral meniscus force by up to 57% (40 N, p=0.014) with applied pivoting loads. This increase was observed only at 30° of flexion. Augmenting ACLR with LET increased lateral meniscus force by 43% (31 N, p=0.041) at 30° of flexion. Compared to the intact knee, sectioning the ACL increased medial meniscus force by up to 102% (73.5N, p<0.001) and 18% (19 N, p=0.01) during the simulated Lachman and anterior drawer, respectively. Augmenting ACLR with LET did not result in a statistically significant change in medial meniscus force during the tests of anterior laxity. For all conditions tested and for both menisci, no statistical significant difference in force was detected between the intact and ACL reconstructed knee.

Conclusion

Our data support ACLR in isolation as an effective strategy to normalize the increased loads on both menisci with ACL deficiency during pivoting and anterior laxity tests. LET augmentation to ACLR may increase lateral meniscal load in flexion, which may affect outcomes in cases of concomitant lateral meniscal pathology. These data can guide clinicians with additional implications of LET augmentation to ACLR and may suggest a more conservative post-surgical management early on in cases of combined ACLR+LET with lateral meniscus pathology.


More ISAKOS 2021: Global Content