A lateral meniscal (LM) disorder is one factor that causes rotational laxity after anterior cruciate ligament (ACL) reconstruction (ACLR). There are different types of irreparable meniscal disorders, one of which is a massive meniscal defect.
Hypothesis/Purpose:
The purpose of this study was to evaluate the kinematic effects of arthroscopic centralization on an irreparable LM defect. The hypothesis was that arthroscopic centralization for an irreparable LM defect with concomitant ACLR would improve knee rotational stability.
Study Design:
Controlled laboratory study.
Methods:
A total of 14 fresh-frozen human cadaveric knees were tested in 4 states: (1) intact ACL and intact lateral meniscus, (2) reconstructed ACL and intact lateral meniscus, (3) reconstructed ACL and lateral meniscus defect, and (4) reconstructed ACL and centralized lateral meniscus. Anatomic ACLR was performed using an 8 mm–diameter hamstring tendon graft. An LM defect (20% of the anteroposterior length) was created arthroscopically, and arthroscopic centralization was performed. Kinematics were analyzed using a 6 degrees of freedom robotic system under 4 knee loads: (1) an 89.0-N anterior tibial load, (2) a 5.0-N·m external rotation tibial torque, (3) a 5.0-N·m internal rotation tibial torque, and (4) a simulated pivot-shift load with a combined 7.0-N·m valgus and 5.0-N·m internal rotation tibial torque.
Results:
LM centralization reduced anterior tibial translation similar to that of the ACLR intact LM state under anterior tibial loading (~2 mm at 30° of flexion) and showed 40% to 100% of tibial displacement in the 4 knee states under simulated pivot-shift loading. The procedure overconstrained the knee under internal rotation tibial torque and simulated pivot-shift loading.
Conclusion:
Arthroscopic centralization reduced knee laxity after ACLR for a massive LM defect in a cadaveric model.
Clinical Relevance:
In cases involving irreparable LM injuries during ACLR, consideration should be given to arthroscopic centralization for reducing knee laxity. However, the procedure may overconstrain the knee in certain motions.
AllenPRDenhamRASwanAV.Late degenerative changes after meniscectomy: factors affecting the knee after operation. J Bone Joint Surg Br. 1984;66(5):666-671.
2.
AraujoPHAsaiSPintoM, et al. ACL graft position affects in situ graft force following ACL reconstruction. J Bone Joint Surg Am. 2015;97(21):1767-1773.
3.
ArnoSHadleySCampbellKA, et al. The effect of arthroscopic partial medial meniscectomy on tibiofemoral stability. Am J Sports Med. 2013;41(1):73-79.
4.
AyeniORChahalMTranMNSpragueS.Pivot shift as an outcome measure for ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2012;20(4):767-777.
5.
BrandonMLHaynesPTBonamoJRFlynnMIBarrettGRShermanMF.The association between posterior-inferior tibial slope and anterior cruciate ligament insufficiency. Arthroscopy. 2006;22(8):894-899.
6.
ChatainFAdeleinePChambatPNeyretP; Société Française d’Arthroscopie. A comparative study of medial versus lateral arthroscopic partial meniscectomy on stable knees: 10-year minimum follow-up. Arthroscopy. 2003;19(8):842-849.
7.
DesandoGGiavaresiGCavalloC, et al. Autologous bone marrow concentrate in a sheep model of osteoarthritis: new perspectives for cartilage and meniscus repair. Tissue Eng Part C Methods. 2016;22(6):608-619.
8.
EkdahlMNozakiMFerrettiMTsaiASmolinskiPFuFH.The effect of tunnel placement on bone-tendon healing in anterior cruciate ligament reconstruction in a goat model. Am J Sports Med. 2009;37(8):1522-1530.
9.
FrankJMMoatsheGBradyAW, et al. Lateral meniscus posterior root and meniscofemoral ligaments as stabilizing structures in the ACL-deficient knee: a biomechanical study. Orthop J Sports Med. 2017;5(6):2325967117695756.
10.
FujieHLivesayGAFujitaMWooSL.Forces and moments in six-DOF at the human knee joint: mathematical description for control. J Biomech. 1996;29(12):1577-1585.
11.
FujishiroHTsukadaSNakamuraTNimuraAMochizukiTAkitaK.Attachment area of fibres from the horns of lateral meniscus: anatomic study with special reference to the positional relationship of anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2017;25(2):368-373.
12.
FukubayashiTKurosawaH.The contact area and pressure distribution pattern of the knee: a study of normal and osteoarthrotic knee joints. Acta Orthop Scand. 1980;51(6):871-879.
13.
HatsushikaDMunetaTNakamuraT, et al. Repetitive allogeneic intraarticular injections of synovial mesenchymal stem cells promote meniscus regeneration in a porcine massive meniscus defect model. Osteoarthritis Cartilage. 2014;22(7):941-950.
14.
JonssonHRiklund-AhlstromKLindJ.Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5-9 years after surgery. Acta Orthop Scand. 2004;75(5):594-599.
15.
JulkeHMainil-VarletPJakobRPBrehmWSchaferBNesicD.The role of cells in meniscal guided tissue regeneration: a proof of concept study in a goat model. Cartilage. 2015;6(1):20-29.
16.
KanamoriAZeminskiJRudyTWLiGFuFHWooSL.The effect of axial tibial torque on the function of the anterior cruciate ligament: a biomechanical study of a simulated pivot shift test. Arthroscopy. 2002;18(4):394-398.
17.
KijowskiRWoodsMAMcGuineTAWilsonJJGrafBKDe SmetAA.Arthroscopic partial meniscectomy: MR imaging for prediction of outcome in middle-aged and elderly patients. Radiology. 2011;259(1):203-212.
18.
KimDAsaiSMoonCW, et al. Biomechanical evaluation of anatomic single- and double-bundle anterior cruciate ligament reconstruction techniques using the quadriceps tendon. Knee Surg Sports Traumatol Arthrosc. 2015;23(3):687-695.
19.
KittlCEl-DaouHAthwalKK, et al. The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee. Am J Sports Med. 2016;44(2):345-354.
20.
KocherMSSteadmanJRBriggsKZurakowskiDSterettWIHawkinsRJ.Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am. 2002;84(9):1560-1572.
21.
KogaHMunetaTWatanabeT, et al. Two-year outcomes after arthroscopic lateral meniscus centralization. Arthroscopy. 2016;32(10):2000-2008.
22.
KogaHMunetaTYagishitaK, et al. Arthroscopic centralization of an extruded lateral meniscus. Arthrosc Tech. 2012;1(2):e209-e212.
23.
KogaHWatanabeTHorieM, et al. Augmentation of the pullout repair of a medial meniscus posterior root tear by arthroscopic centralization. Arthrosc Tech. 2017;6(4):e1335-e1339.
24.
KohYGMoonHKKimYCParkYSJoSBKwonSK.Comparison of medial and lateral meniscal transplantation with regard to extrusion of the allograft, and its correlation with clinical outcome. J Bone Joint Surg Br. 2012;94(2):190-193.
25.
LindangerLStrandTMolsterAOSolheimEInderhaugE.Effect of early residual laxity after anterior cruciate ligament reconstruction on long-term laxity, graft failure, return to sports, and subjective outcome at 25 years. Am J Sports Med. 2021;49(5):1227-1235.
26.
MinamiTMunetaTSekiyaI, et al. Lateral meniscus posterior root tear contributes to anterolateral rotational instability and meniscus extrusion in anterior cruciate ligament-injured patients. Knee Surg Sports Traumatol Arthrosc. 2018;26(4):1174-1181.
27.
MonacoEFerrettiALabiancaL, et al. Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc. 2012;20(5):870-877.
28.
MusahlVCitakMO’LoughlinPFChoiDBediAPearleAD.The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med. 2010;38(8):1591-1597.
29.
NakamuraTLindeMAMarshallBD, et al. Arthroscopic centralization restores residual knee laxity in ACL-reconstructed knee with a lateral meniscus defect. Knee Surg Sports Traumatol Arthrosc. 2019;27(11):3699-3704.
30.
NovarettiJVLianJPatelNK, et al. Partial lateral meniscectomy affects knee stability even in anterior cruciate ligament-intact knees. J Bone Joint Surg Am. 2020;102(7):567-573.
31.
OsterDMGroodESFederSMButlerDLLevyMS.Primary and coupled motions in the intact and the ACL-deficient knee: an in vitro study in the goat model. J Orthop Res. 1992;10(4):476-484.
32.
OzekiNMunetaTKawabataK, et al. Centralization of extruded medial meniscus delays cartilage degeneration in rats. J Orthop Sci. 2017;22(3):542-548.
33.
ShafferBKennedySKlimkiewiczJYaoL.Preoperative sizing of meniscal allografts in meniscus transplantation. Am J Sports Med. 2000;28(4):524-533.
34.
ShoemakerSCMarkolfKL.The role of the meniscus in the anterior-posterior stability of the loaded anterior cruciate-deficient knee: effects of partial versus total excision. J Bone Joint Surg Am. 1986;68(1):71-79.
35.
ShybutTBVegaCEHaddadJ, et al. Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med. 2015;43(4):905-911.
36.
TangXMarshallBWangJH, et al. Lateral meniscal posterior root repair with anterior cruciate ligament reconstruction better restores knee stability. Am J Sports Med. 2019;47(1):59-65.
37.
TangXMarshallBWangJH, et al. Partial meniscectomy does not affect the biomechanics of anterior cruciate ligament reconstructed knee with a lateral posterior meniscal root tear. Knee Surg Sports Traumatol Arthrosc. 2020;28(11):3481-3487.
38.
VerdonkPCVerstraeteKLAlmqvistKF, et al. Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations. Knee Surg Sports Traumatol Arthrosc. 2006;14(8):694-706.
39.
WalkerPSErkmanMJ.The role of the menisci in force transmission across the knee. Clin Orthop Relat Res. 1975;109:184-192.
40.
WatanabeYScyocAVTsudaEDebskiREWooSL.Biomechanical function of the posterior horn of the medial meniscus: a human cadaveric study. J Orthop Sci. 2004;9(3):280-284.
41.
WooSLDebskiREWithrowJDJanaushekMA.Biomechanics of knee ligaments. Am J Sports Med. 1999;27(4):533-543.
42.
WooSLFisherMB.Evaluation of knee stability with use of a robotic system. J Bone Joint Surg Am. 2009;91(suppl1):78-84.
43.
XuYLiuJKramerS, et al. Comparison of in situ forces and knee kinematics in anteromedial and high anteromedial bundle augmentation for partially ruptured anterior cruciate ligament. Am J Sports Med. 2011;39(2):272-278.
