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Influence of Medial Meniscus Bucket-Handle Repair in Setting of Anterior Cruciate Ligament Reconstruction on Tibiofemoral Contact Mechanics: A Biomechanical Study.
Influence of Medial Meniscus Bucket-Handle Repair in Setting of Anterior Cruciate Ligament Reconstruction on Tibiofemoral Contact Mechanics: A Biomechanical Study.
- Source :
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Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association [Arthroscopy] 2019 Aug; Vol. 35 (8), pp. 2412-2420. - Publication Year :
- 2019
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Abstract
- Purpose: To compare the impact of an inside-out repair versus meniscectomy of a medial meniscus bucket-handle tear in restoring native contact areas and pressures across the tibial plateaus in the setting of an anterior cruciate ligament (ACL) reconstruction (ACLR).<br />Methods: Ten fresh-frozen cadaveric knees were tested in 6 knee conditions (1: intact; 2: ACL torn and bucket-handle tear of medial meniscus, flipped; 3: bucket-handle tear of medial meniscus, reduced; 4: bucket-handle tear of medial meniscus, repaired via inside-out vertical mattress suture technique; 5: ACLR with bone patella tendon bone autograft and bucket-handle repair; 6: ACLR and medial meniscus bucket-handle tear debridement) at 4 flexion angles (0°, 30°, 45°, and 60°), under a 1,000-N axial load. Contact area and pressure were measured with Tekscan sensors.<br />Results: ACLR with a concurrent medial meniscectomy for a medial meniscus bucket-handle tear resulted in significantly decreased contact area (P < .05) and increased mean and peak pressure in both the medial and lateral compartments across all tested flexion angles (P < .05). The ACLR with medial meniscectomy state also demonstrated significantly lower contact area than the bucket-handle repair state between 30° and 60° of flexion (all P < .05).<br />Conclusions: Resection of a bucket-handle medial meniscus tear concurrent with an ACLR resulted in significant increases in mean and peak contact pressures in not only the medial but also the lateral compartment. Preservation of the medial meniscus in the face of a bucket-handle tear is essential to more closely restore native tibiofemoral biomechanics.<br />Clinical Relevance: The increased mean and peak tibiofemoral contact pressure seen with excision of a bucket-handle medial meniscus tear would over time result in increased cartilaginous degradation and resultant osteoarthritis. Decreasing both of these factors through concomitant ACLR and inside-out bucket-handle meniscal repairs should improve patient outcomes by restoring knee biomechanics and kinematics closer to that of the native state.<br /> (Copyright © 2019 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Anterior Cruciate Ligament Injuries physiopathology
Cadaver
Humans
Knee Joint surgery
Male
Middle Aged
Suture Techniques
Tibial Meniscus Injuries physiopathology
Anterior Cruciate Ligament Injuries surgery
Anterior Cruciate Ligament Reconstruction methods
Knee Joint physiopathology
Meniscectomy methods
Menisci, Tibial surgery
Range of Motion, Articular physiology
Tibial Meniscus Injuries surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1526-3231
- Volume :
- 35
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
- Publication Type :
- Academic Journal
- Accession number :
- 31395180
- Full Text :
- https://doi.org/10.1016/j.arthro.2019.03.052