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Small lateral meniscus tears propagate over time in ACL intact and deficient knees

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To quantify propagation of small longitudinal tears in the lateral meniscus in ACL intact and deficient knees.

Methods

Using a robotic testing system, 5-Nm of external tibial torque + 5-Nm of valgus torque + 250-N of axial compression was applied to 14 fresh-frozen cadaveric knees while the knees were flexed from 30° to 90°. Knees were divided into two groups: intact (N = 8) and ACL deficient (N = 6). Kinematic data was recorded for four knee states: intact or ACL deficient knee, after posterior arthrotomy, meniscus tear at baseline, and after 500 cycles of the applied loading condition.

Results

Lateral meniscus tear length increased throughout the 500 cycles regardless of the ACL integrity (p < 0.001). Overall, an increase of 28.7% and 26.1% was observed in intact and ACL deficient knees, respectively. In intact knees, external tibial rotation increased with meniscus tear propagation at all flexion angles by up to 45.5% (p = 0.019). In contrast, knee kinematics in ACL deficient knees were not affected by meniscus tear propagation (n.s.). In ACL deficient knees, resultant forces in the lateral meniscus increased at all flexion angles by up to 116.5% (p = 0.012). No differences in forces were observed in the intact knees (n.s.).

Conclusion

The data of this study show that small longitudinal tears in the lateral meniscus propagate significantly regardless of the integrity of the ACL and even after only 100 cycles of knee loading. The propagation of such tears altered kinematics and forces in the knee. Therefore, small, longitudinal lateral meniscus tears that are untreated in current clinical practices may propagate when loaded.

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Acknowledgements

João V. Novaretti has been awarded a scholarship from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Foundation—Programa de Doutorado Sanduíche no Exterior (PDSE)—88881.135480/2016-01 (Brazil). Elmar Herbst received a research fellowship from the AGA—Society of Arthroscopy and Joint Surgery. This paper has been presented at: ISAKOS 2019 Biennial , Congress, ORS 2018 Annual Meeting.

Funding

Support from the University of Pittsburgh Medical Center (UPMC) Sports Medicine Fellowship Grant is gratefully acknowledged.

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Author notes

  1. João V. Novaretti and Elmar Herbst contributed equally to this work co-first authorship.

Authors and Affiliations

  1. Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA

    João V. Novaretti, Elmar Herbst, Calvin K. Chan, Richard E. Debski & Volker Musahl

  2. Orthopaedics and Traumatology Sports Center (CETE), Department of Orthopaedics and Traumatology, Paulista School of Medicine (EPM), Federal University of São Paulo, Rua Estado de Israel 636, São Paulo, SP, 04022-001, Brazil

    João V. Novaretti

  3. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany

    Elmar Herbst

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  1. João V. Novaretti
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Contributions

JVN: conceptualization; data curation; formal analysis; investigation; methodology; project administration; writing—original draft; writing—review and editing. EH: conceptualization; data curation; formal analysis; investigation; methodology; project administration; writing—original draft; writing—review and editing. CKC: data curation; formal analysis; methodology; software; writing—review and editing. RED: conceptualization; funding acquisition; investigation; project administration; resources; supervision; writing—review and editing. VM: conceptualization; funding acquisition; investigation; project administration; resources; supervision; writing—review and editing.

Corresponding author

Correspondence to João V. Novaretti.

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Conflict of interest

Dr. Volker Musahl reports consulting from Smith & Nephew, grant from Smith & Nephew for Educational Fellowship and grant from Arthrex for Educational Fellowship.

Ethical approval

Ethical committee approval was received for this study (CORID #501).

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Novaretti, J.V., Herbst, E., Chan, C.K. et al. Small lateral meniscus tears propagate over time in ACL intact and deficient knees. Knee Surg Sports Traumatol Arthrosc 29, 3068–3076 (2021). https://doi.org/10.1007/s00167-020-06356-z

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  • DOI: https://doi.org/10.1007/s00167-020-06356-z

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