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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Survivability Of Primary Anterior Cruciate Ligament Reconstructions In A Physically High Demand Population Abstract Presentation 6 minutes Ashley Bee Anderson, MD, UNITED STATES Travis Dekker, MD, UNITED STATES Veronika Pav, MS, UNITED STATES Timonthy C Mauntel, PhD, UNITED STATES Matthew T. Provencher, MD, UNITED STATES John M. Tokish, MD, UNITED STATES Jon F. Dickens, MD, UNITED STATES
Effect Of Graft Choice On 6-Year Outcomes Of Revision Anterior Cruciate Ligament Reconstruction In The Multicenter ACL Revision Study (Mars) Cohort Abstract Presentation 6 minutes Rick W. Wright, MD, UNITED STATES
Predicting Subsequent Revision ACL Reconstruction: A Machine Learning Analysis of the Norwegian Knee Ligament Register Abstract Presentation 5 minutes R. Kyle Martin, MD, FRCSC, UNITED STATES Solvejg Wastvedt, BA, UNITED STATES Ayoosh Pareek, MD, UNITED STATES Andreas Persson, MD, PhD, NORWAY Havard Visnes, MD, PT, PhD, NORWAY Anne Marie Fenstad, MSc, NORWAY Gilbert Moatshe, MD, PhD, NORWAY Julian Wolfson, PhD, UNITED STATES Lars Engebretsen, MD, PhD, NORWAY
The Lateral Femoral Notch Sign Entails Increased Rotatory Laxity After Acl-Injury. Pivot Shift Quantification With Surgical Navigation System Abstract Presentation 5 minutes Gian Andrea Lucidi, MD, ITALY Piero Agostinone, MD, ITALY Stefano Di Paolo, Eng, ITALY Alberto Grassi, PhD, ITALY Luca Macchiarola, MD, ITALY Giacomo Dal Fabbro, MD, ITALY Nicola Pizza, MD, ITALY Stefano Zaffagnini, MD, Prof., ITALY
Validation of a Risk Calculator to Personalize Graft Choice and Reduce Rupture Rates for Anterior Cruciate Ligament Reconstruction Abstract Presentation 6 minutes Hana Marmura, BSc, CANADA Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, CANADA Kurt Paul Spindler, MD, UNITED STATES Michael W Kattan, PhD, UNITED STATES Isaac Briskin, MA, UNITED STATES Dianne M. Bryant, PhD, CANADA
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

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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