2015 ISAKOS Biennial Congress ePoster #1351

Medial Compartment and Medial Meniscus Visualization is Improved by Anterior Cruciate Ligament Graft Placement in Chronic Anterior Cruciate Deficient Knees

Christopher J. Vertullo, MBBS, PhD, FRACS(Orth), Gold Coast, QLD AUSTRALIA
Lahann Joseph Wijneyake, MBBS, Gold Coast AUSTRALIA
Jane Grayson, PhD, Gold Coast, QLD AUSTRALIA

Knee Research Australia & Centre for Musculoskeletal Research Griffith University , Gold Coast, Queensland, AUSTRALIA

FDA Status Not Applicable

Summary: ACL Graft placement & tensioning prior to final tibia fixation improved medial compartment visualisation in 85% of chronically ACL deficient knees by preventing anterior tibio-femoral subluxation.




It is customary to perform medial meniscal repair or meniscectomy prior to ACL Graft placement when undertaken as a combined procedure. However, intra-operative anterior tibio-femoral
subluxation in chronic ACL deficient knees can make the medial meniscal surgery more
technically challenging by reducing the medial femoral-tibial compartment working space &
deforming the medial meniscus.
Our hypothesis is that ACL Graft placement & tensioning improves medial compartment visualization in chronically ACL deficient knees by preventing anterior tibio-femoral subluxation.


Standardized medial meniscus & medial compartment intra-operative photographs were
performed in 71 consecutive ACLR undertaken by a single surgeon. Each medial compartment was photographed at 15 degrees of knee flexion and a valgus load, pre to & post ACLR graft placement & manual distal tensioning. The ACLR graft was fixed at the femur via an Endobutton and tensioned using manual traction via 50 Ethibond distal tendon sutures to prevent anterior tibio-femoral subluxation. Menisectomy or repair of the medial meniscus was then undertaken as required. Tibial fixation of the graft was undertaken after completion of the meniscal surgery.
A blinded assessment of the medial compartment pre & post photographs was undertaken by seven
independent orthopaedic surgeons experience in arthroscopic surgery, asking which image
provided the best medial meniscal visualisation.


This study included 52 males, 19 females with a mean age 31.39. Of these 45 were acute ACL ruptures (< 6weeks), 12 sub-acute (6 weeks – 1yr) and 14 chronic (>1yr).
The study had a very high inter-observer reliability of 85%.
85% of the Chronic ACLR’s had better medial meniscal & compartment visualization post ACL
graft insertion. Visualisation was also rated better in the acute group but not in the sub-acute group.


Through our study we were able to validate our hypothesis that medial compartment and medial meniscus visualization is improved by ACL Graft placement & tensioning prior to final tibial fixation in chronically Anterior Cruciate Ligament deficient knees.