The effect of anterior cruciate ligament reconstruction on kinematics of the knee with combined anterior cruciate ligament injury and subtotal medial meniscectomy: an in vitro robotic investigation.
OBJECTIVE
The aims of this study were to determine: (1) the kinematic effect of subtotal medial meniscectomy on the anterior cruciate ligament (ACL)-deficient knee and (2) the effect of ACL reconstruction on kinematics of the knee with combined ACL deficiency and subtotal medial meniscectomy under anterior tibial and simulated quadriceps loads.


METHODS
Eight human cadaveric knees were sequentially tested using a robotic testing system under 4 conditions: intact, ACL deficiency, ACL deficiency with subtotal medial meniscectomy, and single-bundle ACL reconstruction using a bone-patellar tendon-bone graft. Knee kinematics were measured at 0 degrees, 15 degrees, 30 degrees, 60 degrees, and 90 degrees of flexion under an anterior tibial load of 130 N and a quadriceps muscle load of 400 N.


RESULTS
Subtotal medial meniscectomy in the ACL-deficient knee significantly increased anterior and lateral tibial translations under the anterior tibial and quadriceps loads (P < .05). These kinematic changes were larger at high flexion (>or=60 degrees) than at low flexion angles. ACL reconstruction in knees with ACL deficiency and subtotal medial meniscectomy significantly reduced the increased anterior tibial translation, but could not restore anterior translation to the intact level with differences ranging from 2.6 mm at 0 degrees to 5.5 mm at 30 degrees of flexion. ACL reconstruction did not significantly affect the medial-lateral translation and internal-external tibial rotation in the presence of subtotal meniscectomy.


CONCLUSIONS
Subtotal medial meniscectomy in knees with ACL deficiency altered knee kinematics, especially at high flexion angles. ACL reconstruction significantly reduced the increased tibial translation in knees with combined ACL deficiency and subtotal medial meniscectomy, but could not restore the knee kinematics to the intact knee level.


CONCLUSIONS
This study suggests that meniscus is an important secondary stabilizer against anterior and lateral tibial translations and should be preserved in the setting of ACL reconstruction for restoration of optimal knee kinematics and function.
Seon
Jong Keun
JK
Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
Gadikota
Hemanth R
HR
Kozanek
Michal
M
Oh
Luke S
LS
Gill
Thomas J
TJ
Li
Guoan
G
D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001265:Athletic Injuries / Q000601:surgery; D001696:Biomechanical Phenomena; D016025:Bone Transplantation; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D008279:Magnetic Resonance Imaging; D008297:Male; D008592:Menisci, Tibial / Q000502:physiology / Q000601:surgery*; D008875:Middle Aged; D009038:Motion; D017847:Patellar Ligament / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D012371:Robotics; D000070600:Tibial Meniscus Injuries; D014182:Transplantation, Autologous; D016474:Weight-Bearing