Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 23, Issue 8, pp 2360–2366 | Cite as

Iatrogenic injury of the anterior meniscal root attachments following anterior cruciate ligament reconstruction tunnel reaming

  • Jonathan N. Watson
  • Katharine J. Wilson
  • Christopher M. LaPrade
  • Nicholas I. Kennedy
  • Kevin J. Campbell
  • Mark R. Hutchinson
  • Coen A. Wijdicks
  • Robert F. LaPradeEmail author



To determine whether reaming of anterior cruciate ligament (ACL) reconstruction tibial tunnels with a 10-mm-diameter reamer would result in injury to the anterior roots of the medial and lateral menisci in an in vitro model when using a tibial aiming device at two settings (40° and 60°).


Three-dimensional footprints of the ACL and the anterior roots of the menisci were measured for 12 human cadaveric tibias. Measurements were taken before and after attempted reaming of an ACL tibial reconstruction tunnel in the calculated ACL centre using a tibial aiming device set at two angles (40° and 60°).


Iatrogenic injury to the anterior root of the medial meniscus caused by overlap with the reamed tibial tunnel was found in 3/6 specimens in Group 1 (40°) and 0/6 specimens in Group 2 (60°). The average area of iatrogenic injury in Group 1 was 9.6 mm2 (8.6 % of the root). There was iatrogenic injury to the anterior root of the lateral meniscus in 4/6 specimens for both groups. The average area of iatrogenic injury was 20.5 mm2 (28.8 %) for Group 1 and 16.2 mm2 (25.9 %) for Group 2.


Reaming of ACL tibial reconstruction tunnels carries a risk of iatrogenic injury to the anterior meniscus roots, even when tunnels are reamed based on guide pin placement in the calculated centre of the ACL. Reaming at varying tibial aiming device angle settings can affect the obliquity of the tunnel aperture and cause iatrogenic injury to the anterior meniscal roots. Caution should be exercised clinically to avoid iatrogenic injury to both the anterior meniscal roots while reaming tibial tunnels during ACL reconstructions.


Meniscus Anterior cruciate ligament Anterior meniscus root 



This study was funded by the Steadman Philippon Research Institute and did not receive any external funding. The authors would like to acknowledge Grant Dornan, MSc, for his statistical expertise and Max Michalski, MD, MSc, for his assistance with data collection.


  1. 1.
    Aga C, Rasmussen MT, Smith SD, Jansson KS, LaPrade RF, Engebretsen L, Wijdicks CA (2013) Biomechanical comparison of interference screws and combination screw and sheath devices for soft tissue anterior cruciate ligament reconstruction on the tibial side. Am J Sports Med 41:841–848PubMedCrossRefGoogle Scholar
  2. 2.
    Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am 90:1922–1931PubMedCrossRefGoogle Scholar
  3. 3.
    Berlet GC, Fowler PJ (1998) The anterior horn of the medial meniscus: an anatomic study of its insertion. Am J Sports Med 26:540–543PubMedGoogle Scholar
  4. 4.
    Bhatia S, Korth K, Van Thiel GS, Gupta D, Cole BJ, Bach BR Jr, Verma NN (2013) Effect of reamer design on the posteriorization of the tibial tunnel during endoscopic transtibial anterior cruciate ligament reconstruction. Am J Sports Med 41:1282–1289PubMedCrossRefGoogle Scholar
  5. 5.
    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 183:17–23CrossRefGoogle Scholar
  6. 6.
    Feucht MJ, Minzlaff P, Saier T, Lenich A, Imhoff AB, Hinterwimmer S (2013) Avulsion of the anterior medial meniscus root: case report and surgical technique. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-013-2462-7 Google Scholar
  7. 7.
    Harner CD, Mauro CS, Lesniak BP, Romanowski JR (2009) Biomechanical consequences of a tear of the posterior root of the medial meniscus. J Bone Joint Surg Am 91(Suppl 2):257–270PubMedGoogle Scholar
  8. 8.
    Hein CN, Gurske-Deperio J, Ehrensberger MT, Marzo JM (2011) Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement. Knee 18:189–192PubMedCrossRefGoogle Scholar
  9. 9.
    Hoser C, Fink C, Brown C, Reichkendler M, Hackl W, Bartlett J (2001) Long-term results of arthroscopic partial lateral meniscectomy in knees without associated damage. J Bone Joint Surg Br 83-B:513–516CrossRefGoogle Scholar
  10. 10.
    Johannsen AM, Civitarese DM, Padalecki JR, Goldsmith MT, Wijdicks CA, LaPrade RF (2012) Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci. Am J Sports Med 40:2342–2347PubMedCrossRefGoogle Scholar
  11. 11.
    Johnson DL, Swenson TM, Livesay GA, Aizawa H, Fu FH, Harner CD (1995) Insertion-site anatomy of the human menisci: gross, arthroscopic and topographical anatomy as a basis for meniscal transplantation. Arthroscopy 11:386–394PubMedCrossRefGoogle Scholar
  12. 12.
    Jones AO, Houang MTW, Low RS, Wood DG (2006) Medial meniscus posterior root attachment injury and degeneration: MRI findings. Australas Radiol 50:306–313PubMedCrossRefGoogle Scholar
  13. 13.
    Jørgensen U, Sonne-Holm S, Lauridsen F, Rosenklint A (1987) Long-term follow-up of meniscectomy in athletes. A prospective longitudinal study. J Bone Joint Surg Br 69-B:80–83Google Scholar
  14. 14.
    Kohn D, Moreno B (1995) Meniscus insertion anatomy as a basis for meniscus replacement: a morphological cadaveric study. Arthroscopy 11:96–103PubMedCrossRefGoogle Scholar
  15. 15.
    LaPrade CM, James EW, Engebretsen L, LaPrade RF (2014) Anterior medial meniscal root avulsions due to malposition of the tibial tunnel during anterior cruciate ligament reconstruction: two case reports. Knee Surg Sports Traumatol Arthrosc 22:1119–1123PubMedCrossRefGoogle Scholar
  16. 16.
    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 96:471–479PubMedCrossRefGoogle Scholar
  17. 17.
    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 33:569–574PubMedCrossRefGoogle Scholar
  18. 18.
    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 37:124–129PubMedCrossRefGoogle Scholar
  19. 19.
    Navarro-Holgado P, Cuevas-Perez A, Aguayo-Galeote M, Carpintero-Benitez P (2007) Anterior medial meniscus detachment and anterior cruciate ligament tear. Knee Surg Sports Traumatol Arthrosc 15:587–590PubMedCrossRefGoogle Scholar
  20. 20.
    Ohkoshi Y, Takeuchi T, Inoue C, Hashimoto T, Shigenobu K, Yamane S (1997) Arthroscopic studies of variants of the anterior horn of the medial meniscus. Arthroscopy 13:725–730PubMedCrossRefGoogle Scholar
  21. 21.
    Øiestad BE, Holm I, Aune AK, Gunderson R, Myklebust G, Engebretsen L, Fosdahl MA, Risberg MA (2010) Knee function and prevalence of knee osteoarthritis after anterior cruciate ligament reconstruction: a prospective study with 10 to 15 years of follow-up. Am J Sports Med 38:2201–2210PubMedCrossRefGoogle Scholar
  22. 22.
    Padalecki JR, Jansson KS, Smith SD, Dornan GJ, Pierce CM, Wijdicks CA, LaPrade RF (2014) Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: in-situ pullout repair restores derangement of joint mechanics. Am J Sports Med 42:699–707PubMedCrossRefGoogle Scholar
  23. 23.
    Shepard MF, Hunter DM, Davies MR, Shapiro MS, Seeger LL (2002) The clinical significance of anterior horn meniscal tears diagnosed on magnetic resonance images. Am J Sports Med 30:189–192PubMedGoogle Scholar
  24. 24.
    Stein T, Mehling AP, Welsch F, von Eisenhart-Rothe R, Jäger A (2010) Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal repairs. Am J Sports Med 38:1542–1548PubMedCrossRefGoogle Scholar
  25. 25.
    Shrive NG, O’Connor JJ, Goodfellow JW (1978) Load-bearing in the knee joint. Clin Orthop Relat Res 131:279–287PubMedGoogle Scholar
  26. 26.
    Toy JO, Feeley BT, Gulotta LV, Warren RF (2011) Arthroscopic avulsion repair of a pediatric ACL with an anomalous primary insertion into the lateral meniscus. HSS J 7:190–193PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Von Porat A, Roos EM, Roos H (2004) High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis 63:269–273CrossRefGoogle Scholar
  28. 28.
    Vyas D, Harner CD (2012) Meniscus root repair. Sports Med Arthrosc 20:86–94PubMedCrossRefGoogle Scholar
  29. 29.
    Zantop T, Wellmann M, Fu FH, Petersen W (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med 36:65–72PubMedCrossRefGoogle Scholar
  30. 30.
    Ziegler CG, Pietrini SD, Westerhaus BD, Anderson CJ, Wijdicks CA, Johansen S, Engebretsen L, LaPrade RF (2011) Arthroscopically pertinent landmarks for tunnel positioning in single bundle and double bundle anterior cruciate ligament reconstructions. Am J Sports Med 39:743–752PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Jonathan N. Watson
    • 1
  • Katharine J. Wilson
    • 2
  • Christopher M. LaPrade
    • 2
  • Nicholas I. Kennedy
    • 2
  • Kevin J. Campbell
    • 2
  • Mark R. Hutchinson
    • 1
  • Coen A. Wijdicks
    • 2
  • Robert F. LaPrade
    • 2
    • 3
    Email author
  1. 1.Department of Orthopaedic SurgeryUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Steadman Philippon Research InstituteVailUSA
  3. 3.The Steadman ClinicVailUSA

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