Abstract
Purpose
The aim of this study was to evaluate the effects of knee biomechanics with an irreparable lateral meniscus defect using the centralization capsular meniscus support procedure in the setting of the ACL-reconstructed knee in a porcine model. The hypothesis is the arthroscopic centralization will decrease the laxity and rotation of the ACL-reconstructed knee.
Methods
Twelve fresh-frozen porcine knees were tested using a robotic testing system under the following loading conditions: (a) an 89.0 N anterior tibial load; (b) 4.0 N m internal and external rotational torques. Anatomic single-bundle ACL reconstruction with a 7 mm-diameter bovine extensor tendon graft was performed. A massive, middle segment, lateral meniscus defect was created via arthroscopy, and arthroscopic centralization was performed with a 1.4 mm anchor with a #2 suture. The LM states with ACL reconstruction evaluated were: intact, massive middle segment defect and with the lateral meniscus centralization procedure.
Results
The rotation of the ACL reconstructed knee with the lateral meniscus defect was significantly higher than with the centralized lateral meniscus under an external rotational torque at 30° of knee flexion, and under an internal rotational torque at 30° and 45° of knee flexion. There were no systematic and consistent effects of LM centralization under anterior tibial translation.
Conclusions
In this porcine model, the capsular support of middle segment of the lateral meniscus using arthroscopic centralization improved the residual rotational laxity of the ACL-reconstructed knee accompanied with lateral meniscus dysfunction due to massive meniscus defect. This study quantifies the benefit to knee kinematics of arthroscopic centralization by restoring the lateral meniscal function.
Similar content being viewed by others
References
Anz AW, Branch EA, Saliman JD (2014) Biomechanical comparison of arthroscopic repair constructs for meniscal root tears. Am J Sports Med 42:2699–2706
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
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
Chen L, Linde-Rosen M, Hwang SC, Zhou J, Xie Q, Smolinski P, Fu FH (2015) The effect of medial meniscal horn injury on knee stability. Knee Surg Sports Traumatol Arthrosc 23:126–131
Crawford SN, Waterman BR, Lubowitz JH (2013) Long-term failure of anterior cruciate ligament reconstruction. Arthroscopy 29:1566–1571
Feucht MJ, Grande E, Brunhuber J, Rosenstiel N, Burgkart R, Imhoff AB, Braun S (2015) Biomechanical evaluation of different suture materials for arthroscopic transtibial pull-out repair of posterior meniscus root tears. Knee Surg Sports Traumatol Arthrosc 23:132–139
Hatsushika D, Muneta T, Horie M, Koga H, Tsuji K, Sekiya I (2013) Intraarticular injection of synovial stem cells promotes meniscal regeneration in a rabbit massive meniscal defect model. J Orthop Res 31:1354–1359
Hatsushika D, Muneta T, Nakamura T, Horie M, Koga H, Nakagawa Y, Tsuji K, Hishikawa S, Kobayashi E, Sekiya I (2014) Repetitive allogeneic intraarticular injections of synovial mesenchymal stem cells promote meniscus regeneration in a porcine massive meniscus defect model. Osteoarthr Cartil 22:941–950
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
Kamien PM, Hydrick JM, Replogle WH, Go LT, Barrett GR (2013) Age, graft size, and Tegner activity level as predictors of failure in anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med 41:1808–1812
Keklikci K, Yapici C, Kim D, Linde-Rosen M, Smolinski P, Fu FH (2013) The effect of notchplasty in anterior cruciate ligament reconstruction: a biomechanical study in the porcine knee. Knee Surg Sports Traumatol Arthrosc 21:1915–1921
Kijowski R, Woods MA, McGuine TA, Wilson JJ, Graf BK, De Smet AA (2011) Arthroscopic partial meniscectomy: MR imaging for prediction of outcome in middle-aged and elderly patients. Radiology 259:203–212
Kittl C, El-Daou H, Athwal KK, Gupte CM, Weiler A, Williams A, Amis AA (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
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 Jt Surg Am 84-A:1560–1572
Koga H, Muneta T, Watanabe T, Mochizuki T, Horie M, Nakamura T, Otabe K, Nakagawa Y, Sekiya I (2016) Two-year outcomes after arthroscopic lateral meniscus centralization. Arthroscopy 32:2000–2008
Koga H, Muneta T, Yagishita K, Watanabe T, Mochizuki T, Horie M, Nakamura T, Okawa A, Sekiya I (2012) Arthroscopic centralization of an extruded lateral meniscus. Arthrosc Tech 1:e209–e212
Koga H, Nakamae A, Shima Y, Iwasa J, Myklebust G, Engebretsen L, Bahr R, Krosshaug T (2010) Mechanisms for noncontact anterior cruciate ligament injuries: knee joint kinematics in 10 injury situations from female team handball and basketball. Am J Sports Med 38:2218–2225
Koga H, Watanabe T, Horie M, Katagiri H, Otabe K, Ohara T, Katakura M, Sekiya I, Muneta T (2017) Augmentation of the pullout repair of a medial meniscus posterior root tear by arthroscopic centralization. Arthrosc Tech 6:e1335–e1339
Kondo T, Muneta T, Fukui T (2017) Evaluation of the relationship between the static measurement of transverse arch flexibility of the forefoot and gait parameters in healthy subjects. J Phys Ther Sci 29:413–418
LaPrade RF, LaPrade CM, Ellman MB, Turnbull TL, Cerminara AJ, Wijdicks CA (2015) Cyclic displacement after meniscal root repair fixation: a human biomechanical evaluation. Am J Sports Med 43:892–898
Lee DH, Kim JM, Lee BS, Kim KA, Bin SI (2012) Greater axial trough obliquity increases the risk of graft extrusion in lateral meniscus allograft transplantation. Am J Sports Med 40:1597–1605
Minami T, Muneta T, Sekiya I, Watanabe T, Mochizuki T, Horie M, Katagiri H, Otabe K, Ohara T, Katakura M, Koga H (2017) 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
Monaco E, Ferretti A, Labianca L, Maestri B, Speranza A, Kelly MJ, D’Arrigo C (2012) Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc 20:870–877
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
Nakagawa Y, Muneta T, Kondo S, Mizuno M, Takakuda K, Ichinose S, Tabuchi T, Koga H, Tsuji K, Sekiya I (2015) Synovial mesenchymal stem cells promote healing after meniscal repair in microminipigs. Osteoarthr Cartil 23:1007–1017
Nikolic D (1998) Lateral meniscal tears and their evolution in acute injuries of the anterior cruciate ligament of the knee. Arthroscopic analysis. Knee Surg Sports Traumatol Arthrosc 6:26–30
Ozeki N, Muneta T, Kawabata K, Koga H, Nakagawa Y, Saito R, Udo M, Yanagisawa K, Ohara T, Mochizuki T, Tsuji K, Saito T, Sekiya I (2017) Centralization of extruded medial meniscus delays cartilage degeneration in rats. J Orthop Sci 22:542–548
Rosso F, Bisicchia S, Bonasia DE, Amendola A (2015) Meniscal allograft transplantation: a systematic review. Am J Sports Med 43:998–1007
Sakane M, Fox RJ, Woo SL, Livesay GA, Li G, Fu FH (1997) In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res 15:285–293
Shaffer B, Kennedy S, Klimkiewicz J, Yao L (2000) Preoperative sizing of meniscal allografts in meniscus transplantation. Am J Sports Med 28:524–533
Shi D, Zhou J, Yapici C, Linde-Rosen M, Smolinski P, Fu FH (2015) Effect of graft fixation sequence on knee joint biomechanics in double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 23:655–660
Shybut TB, Vega CE, Haddad J, Alexander JW, Gold JE, Noble PC, Lowe WR (2015) Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 43:905–911
Smith NA, MacKay N, Costa M, Spalding T (2015) Meniscal allograft transplantation in a symptomatic meniscal deficient knee: a systematic review. Knee Surg Sports Traumatol Arthrosc 23:270–279
Surer L, Michail K, Koken M, Yapici C, Zhu J, Marshall BD, Linde MA, Smolinski P, Fu FH (2016) The effect of anterior cruciate ligament graft rotation on knee biomechanics. Knee Surg Sports Traumatol Arthrosc 25:1093–1110
Takroni T, Laouar L, Adesida A, Elliott JA, Jomha NM (2016) Anatomical study: comparing the human, sheep and pig knee meniscus. J Exp Orthop 3:35
Verdonk PC, Verstraete KL, Almqvist KF, De Cuyper K, Veys EM, Verbruggen G, Verdonk R (2006) Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations. Knee Surg Sports Traumatol Arthrosc 14:694–706
Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30:660–666
Funding
This study was funded by the Department of Orthopaedic Surgery at the University of Pittsburgh.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Patrick Smolinski, Ph.D., has received supplies for other studies from Arthrex, Inc. Other authors have no conflicts to disclose.
Ethical approval
No ethical approval was required from IACUC.
Informed consent
It is not applicable to this study.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Nakamura, T., Linde, M.A., Marshall, B.D. et al. Arthroscopic centralization restores residual knee laxity in ACL-reconstructed knee with a lateral meniscus defect. Knee Surg Sports Traumatol Arthrosc 27, 3699–3704 (2019). https://doi.org/10.1007/s00167-019-05406-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-019-05406-5