The concomitant lateral meniscus injury increased the pivot shift in the anterior cruciate ligament-injured knee
- 323 Downloads
Concomitant meniscus injuries in the anterior cruciate ligament (ACL) have been suggested to exacerbate rotational laxity. However, the effect is supposed to be so small, if any, that some quantitative pivot-shift measurement is needed. The purpose of this prospective study was to determine the effect of meniscus tear on rotational laxity in ACL-deficient knees by an quantitative measurement. It was hypothesized that a concomitant meniscus tear, especially a lateral one, would induce greater pivot shift.
Fifty-seven unilateral ACL-injured patients (26 men and 31 women, mean age: 24 ± 10 years) were included. The pivot-shift test was performed prior to ACL reconstruction, while a quantitative evaluation using an electromagnetic system to determine tibial acceleration and a clinical grading according to the IKDC were performed. Meniscus injuries were diagnosed arthroscopically, and concomitant meniscus tear was confirmed in 32 knees.
The clinical grade was not different between the ACL-injured knees of patients with and without meniscus tear (n.s.). Tibial acceleration did not show a statistical significant difference (meniscus-injured knees: 1.6 ± 1.1 m/s2 versus meniscus-intact knees: 1.2 ± 0.7 m/s2, n.s.). However, the subgroup analysis demonstrated that there was increased tibial acceleration in ACL-deficient knees with lateral meniscus tear (2.1 ± 1.1 m/s2, n = 13) compared with meniscus-intact knees (p < 0.05), whereas rotational laxity did not increase in the medial meniscus-injured and bilateral-injured knees (1.2 ± 0.9 m/s2, n = 12, n.s. and 1.4 ± 1.1 m/s2, n = 7, n.s., respectively).
A concomitant meniscus tear, especially a lateral meniscus tear, has a significant impact on rotational laxity in ACL-injured knees. When a large pivot shift is observed in the ACL-injured knee, a concomitant meniscus tear should be suspected and an aggressive treatment would be considered. Meniscus injuries should be inspected carefully when substantial pivot shift is encountered in ACL-injured knees.
Level of evidence
Diagnostic study, Level III.
KeywordsAnterior cruciate ligament Meniscus injury Pivot-shift test Quantitative measurement
All authors have made substantial contributions to (1) the conception and design of the study, or acquisition, analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; (3) final approval of the version to be submitted; and (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately resolved. The specific contributions of the authors are as follows: (1) Conception and design of the work; YH, NM, TM, RK. (2) Acquisition, analysis, and interpretation of data for the work: YH, NM, KN, YN, DA, TM. (3) Drafting the article: YH, NM. (4) Critical revision of the article for important intellectual content: YH, NM, KN, KK, TM, RK. (5) Final approval of the version to be published: YH, NM, KN, YN, DA, NK, KK, TM, RK. (6) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: YH, MK, RK.
This study was supported by JSPS KAKENHI Grant Number JP16K10902.
Compliance with ethical standards
Conflict of interest
The authors report that they have no conflicts of interest in the authorship and publication of this article.
The Ethics Committee of Kobe University Graduate School of Medicine approved this study.
- 16.Krych AJ, Wu IT, Desai VS, Murthy NS, Collins MS, Saris DBF et al (2018) High rate of missed lateral meniscus posterior root tears on preoperative magnetic resonance imaging. Orthop J Sports Med 9(4):2325967118765722 6(Google Scholar
- 22.Maeyama A, Hoshino Y, Debandi A, Kato Y, Saeki K, Asai S et al (2011) Evaluation of rotational instability in the anterior cruciate ligament deficient knee using triaxial accelerometer: a biomechanical model in porcine knees. Knee Surg Sports Traumatol Arthrosc 19(8):1233–1238CrossRefPubMedGoogle Scholar
- 26.Musahl V, Getgood A, Neyret P, Claes S, Burnham JM, Batailler C et al (2017) Contributions of the anterolateral complex and the anterolateral ligament to rotatory knee stability in the setting of ACL injury: a roundtable discussion. Knee Surg Sports Traumatol Arthrosc 25(4):997–1008CrossRefPubMedGoogle Scholar
- 31.Nagai K, Hoshino Y, Nishizawa Y, Araki D, Matsushita T, Matsumoto T et al (2015) Quantitative comparison of the pivot shift test results before and after anterior cruciate ligament reconstruction by using the three-dimensional electromagnetic measurement system. Knee Surg Sports Traumatol Arthrosc 23(10):2876–2881CrossRefPubMedGoogle Scholar
- 35.Rotterud JH, Sivertsen EA, Forssblad M, Engebretsen L, Aroen A (2013) Effect of meniscal and focal cartilage lesions on patient-reported outcome after anterior cruciate ligament reconstruction: a nationwide cohort study from Norway and Sweden of 8476 patients with 2-year follow-up. Am J Sports Med 41(3):535–543CrossRefPubMedGoogle Scholar
- 39.Tanaka T, Hoshino Y, Miyaji N, Ibaragi K, Nishida K, Nishizawa Y et al (2018) The diagnostic reliability of the quantitative pivot-shift evaluation using an electromagnetic measurement system for anterior cruciate ligament deficiency was superior to those of the accelerometer and iPad image analysis. Knee Surg Sports Traumatol Arthrosc 26(9):2835–2840CrossRefPubMedGoogle Scholar