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Lateral Meniscus Root Tear in ACL-Injured Patients Results In High-Grade Rotatory Knee Laxity: A Quantitative Pivot Shift Analysis

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Lateral Meniscus Root Tear in ACL-Injured Patients Results In High-Grade Rotatory Knee Laxity: A Quantitative Pivot Shift Analysis

Bálint Zsidai, MD, SWEDEN Gian Andrea Lucidi, MD, ITALY Ryosuke Kuroda, MD, PhD, JAPAN James J. Irrgang, PT, PhD, FAPTA, UNITED STATES Kristian Samuelsson, Prof, MD, PhD, MSc, SWEDEN Stefano Zaffagnini, MD, Prof., ITALY Volker Musahl, MD, Prof., UNITED STATES

Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA, PITTSBURGH, Pennsylvania, UNITED STATES

2023 Congress ePoster Presentation 2023 Congress Not yet rated

Anatomic Location

Knee

Anatomic Structure

Meniscus Ligaments Medial Lateral

Diagnosis / Condition

Instability Tears

Treatment / Technique

Repair / Reconstruction

Diagnosis Method

Physical Examination

Sports Medicine

Biomechanics Outcome Studies Research

Ligaments

ACL

Summary: High-grade pivot shift should raise the index of suspicion for concomitant soft tissue injury, including lateral meniscus posterior root tears, which should be repaired to avoid persistent rotatory knee laxity and further intraarticular injury in patients with ACL tears.

Background

In vitro biomechanical research demonstrated the detrimental impact of lateral meniscus posterior root (LMPR) tears on rotatory laxity in the anterior cruciate ligament (ACL)-injured knee. However, the impact of LMPR tears on the pivot shift (PS) in ACL-injured patients remains unclear. The purpose of this study was to evaluate the effect of LMPR tears on rotatory knee laxity using a clinically validated quantitative pivot shift (QPS) analysis system.

Methods

Patients with ACL injury enrolled in a prospective ACL registry from 2012 to 2020 were retrospectively screened for eligibility. To limit confounders, patients were included if they had primary ACL tears, no concurrent ligamentous or bony injuries requiring operative treatment, and no previous surgeries to either knee. Data pertinent to patient demographics, and manual and instrumented clinical exams were extracted through chart review. Intraoperative data with regards to the presence of a LMPR tear, tear depth, position, and relation to the popliteal hiatus were collected by a single fellowship-trained orthopedic sports medicine surgeon.
Patients were assigned to two cohorts based on the presence (LMPR+) or absence (LMPR-) of an LMPR tear concomitant with ACL injury. Each patient underwent examination under anesthesia, performed by the operating surgeon. Examination included a standardized PS test, measurement of anterior tibial translation (mm) using the Rolimeter, and QPS assessment (mm) with a tablet-based image analysis system (PIVOT App). Descriptive statistics included frequency, proportion (%), median, and interquartile rage (IQR). Between-group comparisons of categorical variables were performed using the Fisher exact and Chi-square tests. Non-normally distributed continuous variables were compared between groups with the Mann-Whitney U test. Level of significance was set at p<0.05.

Results

A total of 111 patients were included in the study, of which 25(23%) were assigned to the LMPR+, and 86(77%) to the LMPR- group. The majority of LMPR tears were localized to zone 1 (n=9,36%) or zone 2 (n=9,36%). Tear depth was considered partial in 15(60%) patients and full in 10 (40%) patients. Of the LMPR tears, 7(28%) were central to the popliteal hiatus. There was no significant difference in age, gender, body mass index and time from injury to surgery between the LMPR+ and LMPR- groups. No difference was observed in anterior tibial translation measured using the Rolimeter between patients with (5.0mm;IQR=3.0) and without (5.0mm;IQR=3.0) LMPR tears (p=0.85). The majority of patients in both LMPR+ (n=37,43%) and LMPR- (n=16,64%) groups had a grade 2 preoperative manual pivot shift. The side-to-side difference in QPS was significantly greater in the LMPR+ (2.4mm;IQR=2.5) compared with the LMPR- (1.9mm;IQR=2.1) group (p=0.033). The prevalence of medial meniscus tears was greater in the LMPR+ (n=17, 68%) compared with the LMPR- (n=34,40%) group(p=0.021).

Conclusion

Preoperative quantitative rotatory knee laxity is significantly greater in patients with concurrent ACL and LMPR tears compared to patients with ACL but no LMPR tears. Consequently, high-grade PS should raise the index of suspicion for concomitant soft tissue injury, including LMPR tears, which should be repaired to avoid persistent rotatory knee laxity and further intraarticular injury in patients with ACL tears.

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Meniscus Transplants Delay Arthroplasty in Patients Over 50 Years of Age ePoster Presentation Kevin R. Stone, MD, UNITED STATES Ann W. Walgenbach, RN, NP, MSN, UNITED STATES Shadera Slatter, MS, UNITED STATES Thomas J. Turek, PhD, UNITED STATES Caroline Ferguson-Dryden, BA, UNITED STATES Marie Dicker, BASc, UNITED STATES Emma Miltenberger, BS, UNITED STATES Riley Horn, BS, UNITED STATES Haley Cowles, BA, UNITED STATES Vivian Liu, BA, UNITED STATES Stephanie Wu, BS, UNITED STATES Mani Vessal, MA, PhD, UNITED STATES
Medial Meniscus Repair only Partially Restores In-Vivo Knee Kinematics after ACL Reconstruction ePoster Presentation Alberto Grassi, PhD, ITALY Piero Agostinone, MD, ITALY Stefano Di Paolo, Eng, ITALY Gian Andrea Lucidi, MD, ITALY Erika Pinelli, MsC, ITALY Gregorio Marchiori, MD, ITALY Marco Bontempi, PhD, ITALY Laura Bragonzoni, Prof., ITALY Stefano Zaffagnini, MD, Prof., ITALY
No Dynamic Extrusion of the Medial Meniscus in Ultrasound Examination in Patients with Confirmed Root Tear Lesion ePoster Presentation Katrin Karpinski, MD, GERMANY Theresa Diermeier, MD, GERMANY Lukas Willinger, MD, GERMANY Andreas B. Imhoff, MD, Prof. Emeritus, GERMANY Andrea E. Achtnich, Assoc. Prof., GERMANY Wolf Petersen, MD, Prof, GERMANY

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Lateral Meniscus Root Tear in ACL-Injured Patients Results In High-Grade Rotatory Knee Laxity: A Quantitative Pivot Shift Analysis

Lateral Meniscus Root Tear in ACL-Injured Patients Results In High-Grade Rotatory Knee Laxity: A Quantitative Pivot Shift Analysis

Background

Methods

Results

Conclusion

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Lateral Meniscus Root Tear in ACL-Injured Patients Results In High-Grade Rotatory Knee Laxity: A Quantitative Pivot Shift Analysis

Lateral Meniscus Root Tear in ACL-Injured Patients Results In High-Grade Rotatory Knee Laxity: A Quantitative Pivot Shift Analysis

Background

Methods

Results

Conclusion

More 2023 ISAKOS Congress Content