Dataset Information

Medial Meniscal Ramp Lesion Repair Concomitant With Anterior Cruciate Ligament Reconstruction Did Not Contribute to Better Anterior Knee Stability and Structural Properties After Cyclic Loading: A Porcine Model.

ABSTRACT:

Purpose

To investigate the biomechanical efficacy of medial meniscal ramp lesion (MMRL) repair in anterior cruciate ligament (ACL) reconstruction regarding the graft protection effect after cyclic loading.

Methods

Specimens were randomized into 2 groups: (1) ACL reconstruction with unaddressed MMRL (Group U; n = 10), and (2) ACL reconstruction with repaired MMRL (Group R; n = 12). The specimens were tested cyclically (2,000 cycles, 0-40 N, 100 mm/min) in the direction of the native ACL and loaded to failure (100 mm/min) on a tensile tester. Statistically significant differences between the structural properties (length changes and anterior translations at the 100th, 500th, 1,000th, 1,500th, and 2,000th cycles, upper yield load, maximum load, linear stiffness, and elongation at failure) under cyclic loading and single-cycle loading were analyzed.

Results

There were no significant differences in length changes and anterior translations at the 100th, 500th, 1,000th, 1,500th, and 2,000th cycles. There were no significant differences in upper yield load (82.4 ± 31.2 N in Group U, 90.0 ± 38.5 N in Group R, P = .62), maximum load (109.9 ± 28.6 N in Group U, 124.0 ± 56.4 N in Group R, P = .48), linear stiffness (12.1 ± 4.7N/mm in Group U, 12.5 ± 4.3 N/mm in Group R, P = .84), or elongation at failure (13.5 ± 7.3 mm in Group U, 16.6 ± 7.5 mm in Group R, P = .30).

Conclusions

Simultaneous MMRL repair at the time of ACL reconstruction did not decrease length changes and anterior translations during cyclic loading. In addition, simultaneous MMRL repair at the time of ACL reconstruction did not contribute to better postoperative structural properties.

Clinical relevance

Simultaneous MMRL repair at the time of ACL reconstruction does not show a graft protective effect after cyclic loading. Graft elongation may occur during early rehabilitation.

SUBMITTER: Matsumoto Y

PROVIDER: S-EPMC8689255 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Publications

Medial Meniscal Ramp Lesion Repair Concomitant With Anterior Cruciate Ligament Reconstruction Did Not Contribute to Better Anterior Knee Stability and Structural Properties After Cyclic Loading: A Porcine Model.

Matsumoto Yuta Y Takahashi Tsuneari T Hatayama Kazuhisa K Kubo Tatsuya T Higuchi Hiroshi H Kimura Masashi M Takeshita Katsushi K

Arthroscopy, sports medicine, and rehabilitation 20211112 6

<h4>Purpose</h4>To investigate the biomechanical efficacy of medial meniscal ramp lesion (MMRL) repair in anterior cruciate ligament (ACL) reconstruction regarding the graft protection effect after cyclic loading.<h4>Methods</h4>Specimens were randomized into 2 groups: (1) ACL reconstruction with unaddressed MMRL (Group U; n = 10), and (2) ACL reconstruction with repaired MMRL (Group R; n = 12). The specimens were tested cyclically (2,000 cycles, 0-40 N, 100 mm/min) in the direction of the nativ ...[more]

PMID: 34977655

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Project description:BackgroundPrevious studies of concomitant meniscal injury in athletes with anterior cruciate ligament (ACL) injury have examined age, sex, body mass index (BMI), injury mechanism, and time from injury to surgery as potential risk factors.PurposeTo identify additional risk factors for concomitant meniscal injury, including preinjury joint laxity and lower extremity alignment, in athletes with sport-related ACL injury.Study designCross-sectional study; Level of evidence, 3.MethodsThis study included 180 participants aged 13 to 26 years who underwent ACL reconstruction (ACLR) after a first-time ACL injury sustained during participation in sport. Contralateral lower extremity alignment and joint laxity were used as surrogate measures for the injured knee before trauma. Concomitant meniscal tear patterns were identified at the time of ACLR. Sex-specific analyses were conducted.ResultsConcomitant meniscal injury was observed in 60.6% of the subjects. The prevalence of concomitant injury was higher in male than female participants (69.9% vs 54.2%; P = .035) due to a higher prevalence of lateral meniscal injuries (56.2% vs 38.3%; P = .018). Among male patients, there was a significant difference in the prevalence of concomitant lateral meniscal tear according to sport participation (≥9 vs <9 h/week: 67.4% vs 35.7%; P = .032). Among male patients, the likelihood of concomitant injury to both the lateral and medial menisci increased by 28.8% for each 1-mm decrease in navicular drop. Among female patients, the likelihood of concomitant injury to the lateral meniscus increased by 15% per degree increase in genu recurvatum and 14% per degree decrease in standing quadriceps angle, with similar effects on the likelihood of concurrent injury to both the lateral and medial menisci.ConclusionMeasures of lower extremity alignment and genu recurvatum previously identified as risk factors for ACL injury were also associated with concomitant meniscal injury in female patients while other risk factors, including BMI and joint laxity, were not. Increased time spent participating in sport and navicular drop were associated with concomitant meniscal injury in male patients.

Project description:BackgroundBoth the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) bear load during athletic tasks of landing, cutting, pivoting, and twisting. As dynamic knee valgus is a purported mechanism for ACL injury, the MCL should bear significant strain load with valgus force.HypothesisThe intact MCL will demonstrate a significant increase in strain upon failure of the ACL at 25° of knee flexion.Study designControlled laboratory study.MethodsIn vivo kinetics/kinematics of 44 healthy athletic participants were measured to determine stratification of injury risk (ie, low, medium, and high) in 3 degrees of knee forces/moments (knee abduction moment, anterior tibial shear, and internal tibial rotation). These stratified kinetic values were input into a cadaveric impact simulator to assess ligamentous strain during a simulated landing task. Uniaxial and multiaxial load cells and differential variable reluctance transducer strain sensors were utilized to collect mechanical data for analysis. Conditions of external loads applied to the cadaveric limbs were varied and randomized.ResultsACL strain increased with increased dynamic knee abduction moment (χ2[5] = 14.123, P = .0148). The most extreme dynamic knee abduction moment condition demonstrated significantly higher ACL strain compared with lower loaded trials (P≤ .0203). Similarly, MCL strain increased with dynamic knee abduction moment (χ2[5] = 36.578, P < .0001). Matched-pairs analysis compared ACL strain with MCL strain (maximum ACL strain - maximum MCL strain) and demonstrated high strain for the ACL versus the MCL (S177 = 6223.5, P < .0001).ConclusionAlthough significant, MCL strain had minimal increase with increased dynamic knee abduction moment, and the event of ACL failure did not significantly increase MCL strain when compared with high dynamic knee abduction moment conditions in the cadaveric model. The ACL bears more strain than the MCL at increasing amounts of dynamic knee abduction moment at 25° of knee flexion, which may explain the limited concomitant MCL injury rate that can occur during a dynamic valgus collapse of the knee.Clinical relevanceThese characteristics of ACL and MCL strain are important to understand the mechanisms that drive these injuries at the knee and will improve rehabilitation and injury prevention techniques.

Dataset Information

Medial Meniscal Ramp Lesion Repair Concomitant With Anterior Cruciate Ligament Reconstruction Did Not Contribute to Better Anterior Knee Stability and Structural Properties After Cyclic Loading: A Porcine Model.

Purpose

Methods

Results

Conclusions

Clinical relevance

Publications

Medial Meniscal Ramp Lesion Repair Concomitant With Anterior Cruciate Ligament Reconstruction Did Not Contribute to Better Anterior Knee Stability and Structural Properties After Cyclic Loading: A Porcine Model.

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