Abstract
Purpose
In longstanding chronic anterior cruciate ligament (ACL) insufficiency, we identified an abnormal movement of the posterior medial meniscal horn, likely due to insufficiency of the posteromedial meniscotibial ligament. Passing from extension to flexion or vice versa, the medial posterior horn slides below the posterior rim of the tibia exposing the tibial plateau. Fixation with suture anchors of the meniscotibial ligament through a posteromedial portal restored normal meniscotibial tension and reduced instability of the meniscal posterior horn. The purpose of the present study was to present the arthroscopic features of posterior medial meniscus instability and to report results following arthroscopic repair.
Methods
During the two-year study period, from 2007 through 2008, this arthroscopic feature was detected in 12 patients, 5 patients had failure of a previous ACL reconstruction and 7 patients had delay in ligamentous reconstruction for various reasons. All patients were affected by severe anterior–posterior translation with 11.3 ± 4.3 mm of side-to-side difference at KT-2000 and by associated rotatory laxity with grade 3 of pivot shift.
Results
At follow-up of 1 year, the combined ACL reconstruction and fixation of the posteromedial horn showed a reduction in the rotatory and anteroposterior laxity.
Conclusions
This study suggests the importance of a proper arthroscopic evaluation of the posterior medial capsule in patients with chronic ACL insufficiency and highlights the potential presence of an unstable posterior horn of the medial meniscus as an indirect arthroscopic sign of peripheral laxity.
Level of evidence
Retrospective chart review, Level IV.
Similar content being viewed by others
References
Amin KB, Cosgarea AJ (1999) The value of the intercondylar notch visualisation of the posteromedial and posterolateral compartments during knee arthroscopy. Arthroscopy 8:813–817
Boytim MJ, Smith JP (1995) Arthroscopic visualisation of the knee. Clin Orthop Relat Res 310:82–86
Boxheimer L, Lutz AM, Zanetti M, Treiber K, Labler L, Marincek B, Weishapt D (2006) Characteristics of displaceable and non displaceable meniscal tears at kinematic MR imaging of the knee. Radiology 238:221–231
Choi C-J, Choi Y-J, Lee J-J, Choi C-H (2010) Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. Arthroscopy 26:1602–1606
Church S, Keating JF (2005) Reconstruction of the anterior cruciate ligament: timing of surgery and the incidence of meniscal tears and degenerative change. J Bone Joint Surg Br 87:1639–1642
Foster A, Butcher C, Turner PG (2005) Changes in arthroscopic findings in the anterior cruciate ligament deficient knee prior to reconstructive surgery. Knee 12:33–35
Gillquist J (1979) Arthroscopy of the posterior compartments of the knee joint. Int Orthop 3:13–18
Griffith CJ, Wijdicks CA, LaPrade FR, Armitage BM, Johansen Engebretsen L (2009) Force measurements on the posterior oblique ligament and superficial medial collateral ligament proximal and distal divisions to applied loads. Am J Sports Med 37:140–148
Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities: part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am 58:159–172
Hughston JC, Eilers AF (1973) The role of the posterior oblique ligament in repairs of acute medial (collateral) ligament tears of the knee. J Bone Joint Surg Am 55:923–940
Kale A, Kopuz C, Dioici F, Tevfik Demir M, Çorumlu U, Ince Y (2010) Anatomic and arthroscopic study of the medial meniscal horns’ insertions. Knee Surg Sports Traumatol Arthrosc 18:754–759
Kim YJ, Kim JG, Chang SH, Shim JC, Kim SB, Lee MY (2010) Posterior root tear of the medial meniscus in multiple knee ligament injuries. Knee 17:324–328
Keene GC, Bickerstaff D, Rae PJ, Paterson RS (1993) The natural history of meniscal tears in anterior cruciate ligament insufficiency. Am J Sports Med 21:672–679
Kessler MA, Behhrend H, Henz S, Stutz G, Rukavina A, Kuster MS (2008) Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment. Knee Surg Traumatol Arthrosc 16:442–448
Lee YG, Shim J-C, Choi YS, Kim JG, Lee GH, 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
Lee JH, Hwang BY, Lim YJ, Song JH (2009) Radial tear in the roots of the posterior horns of both the medial and lateral menisci combined with anterior cruciate ligament: a case report. Knee Surg Traumatol Arthrosc 17:1340–1343
Levy IM, Torzilli PA, Warren RF (1982) The effect of medial meniscectomy on anterior–posterior motion of the knee. L Bone Joint Surg Am 64:883–888
Lubowitz JH, Rossi MJ, Baker BS, Guttmann D (2004) Arthroscopic visualisation of the posterior compartments of the knee. Arthroscopy 7:675–680
Magnussen RA, Mansour AA, Carey JL, Spindler KP (2009) Meniscus status at anterior cruciate ligament reconstruction associated with radiographic signs of osteoarthritis at 5–10 year follow-up. J Knee Surg 22:347–357
Naranje S, Mittal R, Nag H, Sharma R (2008) Arthroscopic and magnetic resonance imaging evaluation of meniscus lesions in the chronic anterior cruciate ligament lesions in the chronic anterior cruciate ligament-deficient knee. Arthroscopy 24:1045–1051
Papageorgiou CD, Gil JE, Kanamori A, Fenwick JA, Woo SL, Fu FH (2001) The biomechanical interdependence between the anterior cruciate ligament replacement graft and the medial meniscus. Am J Sports Med 29:226–231
Robinson JR, Bull AM, Thomas RR, Amis AA (2006) The role of the medial collateral ligament and posteromedial capsule in controlling knee laxity. Am J Sports Med 34:1815–1823
Sims WF, Jacobson KE (2004) The posteromedial corner of the knee. Medial sided injury patterns revisited. Am J Sport Med 32:337–345
Spencer Jones R, Keene GCR, Learmonth DJA, Bickerstaff D, Nawana NS, Costi JJ, Pearcy MJ (1996) Direct measurement of hoop strains in the intact and torn human medial meniscus. Clin Biomech 11:295–330
Tandogan RN, Taşer O, Kayaalp A, Taşkiran E, Pinar H, Alparslan B, Alturfan A (2004) Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc 12:262–270
Vasara AI, Jurvelin JS, Peterson L, Kiviranta I (2005) Arthroscopic cartilage indentation and cartilage lesions of anterior cruciate ligament-deficient knees. Am J Sports Med 33:408–414
Vedi V, Williams A, Tennant SJ, Spouse E, Hunt DM, Gedroic WM (1999) Meniscal movement: an in vivo study using dynamic MRI. J Bone Joint Surg Br 81:37–41
Zysk SP, Refior HJ (2000) Operative or conservative treatment of the acutely torn anterior cruciate ligament in middle-aged patients: a follow-up study of 133 patients between the ages of 40 and 59 years. Arch Orthop Trauma Surg 120:59–64
Wang CJ, Walker PS (1974) Rotatory laxity of the human knee joint. J Bone Joint Surg Am 56:161–170
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mariani, P.P. Posterior horn instability of the medial meniscus a sign of posterior meniscotibial ligament insufficiency. Knee Surg Sports Traumatol Arthrosc 19, 1148–1153 (2011). https://doi.org/10.1007/s00167-011-1424-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-011-1424-1