Skip to main content
SpringerLink
Log in

Lateral meniscus posterior root tear contributes to anterolateral rotational instability and meniscus extrusion in anterior cruciate ligament-injured patients

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purposes of this study were to investigate (1) meniscus status and clinical findings in anterior cruciate ligament (ACL)-injured patients to clarify associations between the meniscus posterior root tear (PRT) and knee instability, and (2) magnetic resonance imaging (MRI) findings of the PRT to clarify sensitivity and specificity of MRI and prevalence of meniscus extrusion.

Methods

Three hundred and seventeen patients with primary ACL reconstruction were included. PRTs for both medial and lateral sides were confirmed by reviewing surgical records. Preoperative MRI was reviewed to evaluate sensitivity and specificity of the PRT and meniscus extrusion width (MEW). Clinical information regarding the number of giving-way episodes, preoperative KT-1000 measurements and preoperative pivot shift was also assessed.

Results

Thirty-nine patients had a lateral meniscus (LM) PRT, whereas only four patients had a medial meniscus PRT. One hundred and seventeen patients had no meniscus tear (control). Twenty-eight patients (71.8%) showed positive signs of the LMPRT based on at least one view of MR images, with the coronal view showing the highest sensitivity. MEW in the LMPRT group was significantly larger than that in the control group. The preoperative pivot shift test grade in the LMPRT group was significantly greater than that in the control group. There were no significant differences in other parameters.

Conclusions

In ACL-injured patients, the LMPRT was associated with ALRI as well as with meniscus extrusion. The coronal view of MRI was useful in identifying the LMPRT, although its sensitivity was not high. Therefore, surgeons should prepare to repair PRTs at the time of ACL reconstruction regardless of MRI findings, and they should make every effort to repair the LMPRT.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Anderson L, Watts M, Shapter O et al (2010) Repair of radial tears and posterior horn detachments of the lateral meniscus: minimum 2-year follow-up. Arthroscopy 26:1625–1632

    Article  PubMed  Google Scholar 

  2. Ayeni OR, Chahal M, Tran MN, Sprague S (2012) Pivot shift as an outcome measure for ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 20:767–777

    Article  PubMed  Google Scholar 

  3. Berthiaume MJ, Raynauld JP, Martel-Pelletier J et al (2005) Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging. Ann Rheum Dis 64:556–563

    Article  PubMed  Google Scholar 

  4. Brandon ML, Haynes PT, Bonamo JR, Flynn MI, Barrett GR, Sherman MF (2006) The association between posterior-inferior tibial slope and anterior cruciate ligament insufficiency. Arthroscopy 22:894–899

    Article  PubMed  Google Scholar 

  5. Brody JM, Lin HM, Hulstyn MJ, Tung GA (2006) Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear. Radiology 239:805–810

    Article  PubMed  Google Scholar 

  6. Choi SH, Bae S, Ji SK, Chang MJ (2012) The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc 20:2098–2103

    Article  PubMed  Google Scholar 

  7. Costa CR, Morrison WB, Carrino JA (2004) Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? Am J Roentgenol 183:17–23

    Article  Google Scholar 

  8. Daniel DM, Malcom LL, Losse G, Stone ML, Sachs R, Burks R (1985) Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am 67:720–726

    Article  CAS  PubMed  Google Scholar 

  9. De Smet AA, Blankenbaker DG, Kijowski R, Graf BK, Shinki K (2009) MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard. Am J Roentgenol 192:480–486

    Article  Google Scholar 

  10. De Smet AA, Mukherjee R (2008) Clinical, MRI, and arthroscopic findings associated with failure to diagnose a lateral meniscal tear on knee MRI. Am J Roentgenol 190:22–26

    Article  Google Scholar 

  11. Forkel P, Herbort M, Schulze M et al (2013) Biomechanical consequences of a posterior root tear of the lateral meniscus: stabilizing effect of the meniscofemoral ligament. Arch Orthop Trauma Surg 133:621–626

    Article  PubMed  Google Scholar 

  12. Forkel P, Herbort M, Sprenker F, Metzlaff S, Raschke M, Petersen W (2014) The biomechanical effect of a lateral meniscus posterior root tear with and without damage to the meniscofemoral ligament: efficacy of different repair techniques. Arthroscopy 30:833–840

    Article  PubMed  Google Scholar 

  13. Forkel P, Reuter S, Sprenker F et al (2015) Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system. Knee Surg Sports Traumatol Arthrosc 23:112–118

    Article  PubMed  Google Scholar 

  14. Guermazi A, Eckstein F, Hayashi D et al (2015) Baseline radiographic osteoarthritis and semi-quantitatively assessed meniscal damage and extrusion and cartilage damage on MRI is related to quantitatively defined cartilage thickness loss in knee osteoarthritis: the Multicenter Osteoarthritis Study. Osteoarthr Cartil 23:2191–2198

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Harper KW, Helms CA, Lambert HS 3rd, Higgins LD (2005) Radial meniscal tears: significance, incidence, and MR appearance. Am J Roentgenol 185:1429–1434

    Article  Google Scholar 

  16. Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234

    Article  CAS  PubMed  Google Scholar 

  17. Hwang BY, Kim SJ, Lee SW et al (2012) Risk factors for medial meniscus posterior root tear. Am J Sports Med 40:1606–1610

    Article  PubMed  Google Scholar 

  18. Jonsson H, Riklund-Ahlstrom K, Lind J (2004) Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5–9 years after surgery. Acta Orthop Scand 75:594–599

    Article  PubMed  Google Scholar 

  19. Kittl C, El-Daou H, Athwal KK et al (2016) The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee. Am J Sports Med 44:345–354

    Article  PubMed  Google Scholar 

  20. Kocher MS, Steadman JR, Briggs K, Zurakowski D, Sterett WI, Hawkins RJ (2002) Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am 84:1560–1572

    Article  PubMed  Google Scholar 

  21. Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32:629–634

    Article  PubMed  Google Scholar 

  22. Koga H, Muneta T, Watanabe T et al (2016) Two-year outcomes after arthroscopic lateral meniscus centralization. Arthroscopy 32:2000–2008

    Article  PubMed  Google Scholar 

  23. Koga H, Muneta T, Yagishita K et al (2014) Effect of femoral tunnel position on graft tension curves and knee stability in anatomic double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 22:2811–2820

    Article  PubMed  Google Scholar 

  24. Kuroda R, Hoshino Y, Araki D et al (2012) Quantitative measurement of the pivot shift, reliability, and clinical applications. Knee Surg Sports Traumatol Arthrosc 20:686–691

    Article  PubMed  Google Scholar 

  25. LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF (2015) Meniscal root tears: a classification system based on tear morphology. Am J Sports Med 43:363–369

    Article  PubMed  Google Scholar 

  26. LaPrade CM, Jansson KS, Dornan G, Smith SD, Wijdicks CA, LaPrade RF (2014) Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs. J Bone Joint Surg Am 96:471–479

    Article  PubMed  Google Scholar 

  27. Lee DH, Lee BS, Kim JM et al (2011) Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 19:222–229

    Article  PubMed  Google Scholar 

  28. Lee YG, Shim JC, Choi YS, Kim JG, Lee GJ, Kim HK (2008) Magnetic resonance imaging findings of surgically proven medial meniscus root tear: tear configuration and associated knee abnormalities. J Comput Assist Tomogr 32:452–457

    Article  PubMed  Google Scholar 

  29. Lerer DB, Umans HR, Hu MX, Jones MH (2004) The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Skeletal Radiol 33:569–574

    Article  CAS  PubMed  Google Scholar 

  30. Levy IM, Torzilli PA, Warren RF (1982) The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am 64:883–888

    Article  CAS  PubMed  Google Scholar 

  31. Markolf KL, Jackson SR, McAllister DR (2012) Force measurements in the medial meniscus posterior horn attachment: effects of anterior cruciate ligament removal. Am J Sports Med 40:332–338

    Article  PubMed  Google Scholar 

  32. Marzo JM, Gurske-DePerio J (2009) Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications. Am J Sports Med 37:124–129

    Article  PubMed  Google Scholar 

  33. Monaco E, Ferretti A, Labianca L et al (2012) Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc 20:870–877

    Article  CAS  PubMed  Google Scholar 

  34. Musahl V, Citak M, O’Loughlin PF, Choi D, Bedi A, Pearle AD (2010) The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 38:1591–1597

    Article  PubMed  Google Scholar 

  35. Musahl V, Rahnemai-Azar AA, Costello J et al (2016) The influence of meniscal and anterolateral capsular injury on knee laxity in patients with anterior cruciate ligament injuries. Am J Sports Med 44:3126–3131

    Article  PubMed  Google Scholar 

  36. Nakajima H, Kondo M, Kurosawa H, Fukubayashi T (1979) Insufficiency of the anterior cruciate ligament. Review of our 118 cases. Arch Orthop Trauma Surg 95:233–240

    Article  CAS  PubMed  Google Scholar 

  37. Nakamura K, Koga H, Sekiya I et al (2015) Evaluation of pivot shift phenomenon while awake and under anaesthesia by different manoeuvres using triaxial accelerometer. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3740-3

    Google Scholar 

  38. Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, Tandogan RN (2008) Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 16:849–854

    Article  PubMed  Google Scholar 

  39. Rasmussen MT, Nitri M, Williams BT et al (2016) An in vitro robotic assessment of the anterolateral ligament, part 1: secondary role of the anterolateral ligament in the setting of an anterior cruciate ligament injury. Am J Sports Med 44:585–592

    Article  PubMed  Google Scholar 

  40. Robb C, Kempshall P, Getgood A et al (2015) Meniscal integrity predicts laxity of anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 23:3683–3690

    Article  PubMed  Google Scholar 

  41. Robinson J, Carrat L, Granchi C, Colombet P (2007) Influence of anterior cruciate ligament bundles on knee kinematics: clinical assessment using computer-assisted navigation. Am J Sports Med 35:2006–2013

    Article  PubMed  Google Scholar 

  42. Schillhammer CK, Werner FW, Scuderi MG, Cannizzaro JP (2012) Repair of lateral meniscus posterior horn detachment lesions: a biomechanical evaluation. Am J Sports Med 40:2604–2609

    Article  PubMed  Google Scholar 

  43. Shybut TB, Vega CE, Haddad J et al (2015) Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 43:905–911

    Article  PubMed  Google Scholar 

  44. Song GY, Zhang H, Wang QQ, Zhang J, Li Y, Feng H (2016) Risk factors associated with grade 3 pivot shift after acute anterior cruciate ligament injuries. Am J Sports Med 44:362–369

    Article  PubMed  Google Scholar 

Download references

Authors’ contributions

TMi analysed the data and drafted the manuscript. TMu conducted the study. IS conducted the study. TW, TMo, MH, HKa and MK collected the data. KO and TO analysed the data. HKo designed the initial plan, conducted the study and completed the final manuscript. All authors read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Takao Minami, Takeshi Muneta, Ichiro Sekiya, Toshifumi Watanabe, Tomoyuki Mochizuki, Masafumi Horie, Hiroki Katagiri, Koji Otabe, Toshiyuki Ohara, Mai Katakura & Hideyuki Koga

  2. Department of Orthopaedic Surgery, Wakayama Medical University, 811-1, Kimiidera, Wakayama City, Wakayama, 641-8509, Japan

    Takao Minami

Authors
  1. Takao Minami
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takeshi Muneta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ichiro Sekiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Toshifumi Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomoyuki Mochizuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masafumi Horie
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroki Katagiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Koji Otabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Toshiyuki Ohara
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mai Katakura
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hideyuki Koga
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hideyuki Koga.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

No funding was received for this study.

Ethical approval

This study was approved by the institutional Review Board in Tokyo Medical and Dental University (research protocol identification number: 1146).

Informed consent

All participants provided informed written consent.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Minami, T., Muneta, T., Sekiya, I. 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 26, 1174–1181 (2018). https://doi.org/10.1007/s00167-017-4569-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-017-4569-8

Keywords

Search

Navigation