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J Knee Surg 2021; 34(07): 784-792
DOI: 10.1055/s-0039-3402483
Original Article

Impact of Medial Meniscotibial Ligament Disruption Compared to Peripheral Medial Meniscal Tear on Knee Biomechanics

Patrick A. Smith
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
2   Columbia Orthopaedic Group, Columbia, Missouri
,
Joseph L. Humpherys
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
3   Department of Orthopaedic Surgery and Sports Medicine, Regional Health Orthopedic & Specialty Hospital, Rapid City, Missouri
,
James P. Stannard
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
4   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
,
James L. Cook
1   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
4   Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri
› Author Affiliations
Funding This work was supported by The Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense, through the Peer Reviewed Orthopaedic Research Program under Award No. W81XWH-18-1-0430. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense.
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Abstract

Medial meniscotibial ligament (MTL) lesions may go unrecognized and untreated and have detrimental impact on knee biomechanics and joint pathology. Therefore, this study was designed to compare the biomechanical impact of midbody MTL disruption to corresponding peripheral medial meniscal (PMM) tears in anterior cruciate ligament (ACL) intact and ACL-deficient cadaveric knees. Cadaveric knees (n = 12; 6 matched pairs) were tested for laxity and ACL strain under anterior, valgus, and external rotation loading at 0, 30, and 90 degree of flexion. Knees were randomly assigned to ACL-intact (n = 6) or ACL-deficient (n = 6) groups. Large midbody MTL disruption or corresponding PMM tears were created (n = 3/group) and knees retested. PMM tears were repaired arthroscopically with inside-out suturing, and MTL lesions were repaired with suture anchors via an open approach. Knees were retested after repair. Biomechanical testing data were compared for statistically significant differences. Large MTL and PMM lesions were associated with significant increases in ACL strain, anterior laxity at 0, 30, and 90 degrees (p = 0.006), valgus laxity (p = 0.0012), and external rotation laxity (p = 0.0003) compared with intact knees. Repair of each lesion restored knee stability and reduced ACL strain to intact levels. In ACL-deficient knees, there was significantly increased anterior, valgus, and external rotation laxity compared with the ACL-intact state and MTL and PMM lesions further increased laxity at all angles. However, differences were not statistically significant and repair of meniscal lesions alone did not restore stability to ACL-deficient knees. These results highlight the need to recognize medial MTL injury and perform an appropriate repair procedure to restore knee stability and protect against excessive ACL strain.

Keywords

medial meniscus - meniscotibial ligament disruption - anterior cruciate ligament - biomechanics

Authors' Contributions

All authors have read and approved the final submitted manuscript. P.A.S., J.L.H., J.P.S., J.L.C.: substantial contributions to research design, acquisition, analysis of interpretation of data; P.A.S., J.L.H., J.P.S., J.L.C.: drafting the paper and revising it critically; P.A.S., J.L.H., J.P.S., J.L.C.: approval of the submitted and final versions.




Publication History

Received: 29 October 2019

Accepted: 11 November 2019

Article published online:
08 January 2020

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