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.

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Same Knee, Different Goals: Patients and Surgeons have Different Priorities Related to ACL Reconstructions and Surgeons are Resistant to Changing Clinical Practice Abstract Presentation 4 minutes Hana Marmura, MPT, PhD, UNITED STATES Dianne M. Bryant, PhD, CANADA Trevor B. Birmingham, PT, PhD, CANADA Kurt Paul Spindler, MD, UNITED STATES Christopher C. Kaeding, MD, UNITED STATES Tim Spalding, FRCS(Orth), UNITED KINGDOM Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR
Lower Socioeconomic Status Adversely Affects Access To Care And The Rate Of Instability Events And Bucket Handle Meniscus Tears Following Anterior Cruciate Ligament Tears Abstract Presentation 6 minutes Edward S. Chang, MD, UNITED STATES Blake M. Bodendorfer, MD, UNITED STATES Andrew Curley, MD, UNITED STATES David X. Wang, MD, UNITED STATES Christine Conroy, MD, UNITED STATES Mark Hopkins, MD, UNITED STATES Brian McCormick, MD, UNITED STATES Caroline Fryar, MD, UNITED STATES
Acl Deficiency Influences Medio-Lateral Tibial Alignment And Knee Varus–Valgus During In Vivo Activities Abstract Presentation 3 minutes Piero Agostinone, MD, ITALY Stefano Di Paolo, Eng, PhD, ITALY Alberto Grassi, PhD, ITALY Marco Bontempi, PhD, ITALY Erika Pinelli, MsC, ITALY Laura Bragonzoni, Prof., ITALY Stefano Zaffagnini, MD, Prof., ITALY
Outcomes Following Anterior Cruciate Ligament Reconstruction in Young Patients: An Observational Study. ePoster Presentation Kunal Mohan, MB MCh MRCSI, IRELAND David Cooper, MB MRCSI, IRELAND Niall McGoldrick, MB MCh FRCS (Tr & Orth), IRELAND Martin Davey, MB MCh MRCSI, IRELAND Megan Diack, MBCHB, MRCSI, MCh, IRELAND Paula McQuail, MB FRCSI, IRELAND Fintan J. Shannon, FRCS (Tr/Orth), IRELAND
Comparison of three different Quadriceps Tendon ACL graft to BTB and Semi-T grafts: A biomechanical study ePoster Presentation Marc Jacob Strauss, MD, NORWAY Jonathan Miles, M.S, UNITED STATES Mitchell Iung Kennedy, BS, UNITED STATES Gilbert Moatshe, MD, PhD, NORWAY Grant J Dornan, MS, UNITED STATES Martin Lind, MD, PhD, Prof., DENMARK Lars Engebretsen, MD, PhD, NORWAY Robert F. LaPrade, MD, PhD, UNITED STATES
Risk Factors for Grade 3 Pivot Shift in Acute ACL-Injured Knees Abstract Presentation 5 minutes Adnan Saithna, MD, FRCS, UNITED STATES Edoardo Monaco, MD, ITALY Edoardo Gaj, MD, ITALY Valerio Andreozzi, ITALY Alessandro Annibaldi, MD, ITALY Alessandro Carrozzo, MD, ITALY Thais Dutra Vieira, MD, FRANCE Bertrand Sonnery-Cottet, MD, PhD, FRANCE Andrea Ferretti, Prof., ITALY
Adding A Lateral Extra-Articular Tenodesis Significantly Reduces Acl Graft Rupture Rates In Pediatric And Adolescent Patients When Compared To Isolated Acl Reconstruction Abstract Presentation 5 minutes Andrea Ferretti, Prof., ITALY Adnan Saithna, MD, FRCS, UNITED STATES Alessandro Carrozzo, MD, ITALY Alessandro Annibaldi, MD, ITALY Fabio Marzilli, MD, ITALY Edoardo Monaco, MD, ITALY
Acl - Pcl Fixation Sequence During Multi-Ligament Knee Reconstruction Does Not Affect Knee Laxity Abstract Presentation 6 minutes Carola F. van Eck, MD, PhD, FAAOS, UNITED STATES Aly Maher Fayed, MD, EGYPT Ryo Kanto, MD, JAPAN Taylor M. Price, MS, UNITED STATES Michael Dinenna, BS, UNITED STATES Monica A. Linde, MSIE, RN, UNITED STATES Patrick J. Smolinski, PhD, UNITED STATES

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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

Background

Purpose

Methods

Results

Conclusion

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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

Background

Purpose

Methods

Results

Conclusion

More ISAKOS 2021: Global Content