title: Longitudinal tear of the medial meniscus posterior horn in the anterior cruciate ligament-deficient knee significantly influences anterior stability.
abstract: BACKGROUND
  Longitudinal tears of the medial meniscus posterior horn (MMPH) are commonly associated with a chronic anterior cruciate ligament (ACL) deficiency. Many studies have demonstrated the importance of the medial meniscus in terms of limiting the amount of anterior-posterior tibial translation in response to anterior tibial loads in ACL-deficient knees.
  
  
  OBJECTIVE
  An MMPH tear in an ACL-deficient knee increases the anterior-posterior tibial translation and rotatory instability. In addition, MMPH repair will restore the tibial translation to the level before the tear.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Ten human cadaveric knees were tested sequentially using a custom testing system under 5 conditions: intact, ACL deficient, ACL deficient with an MMPH peripheral longitudinal tear, ACL deficient with an MMPH repair, and ACL deficient with a total medial meniscectomy. The knee kinematics were measured at 0°, 15°, 30°, 60°, and 90° of flexion in response to a 134-N anterior and 200-N axial compressive tibial load. The rotatory kinematics were also measured at 15° and 30° of flexion in a combined rotatory load of 5 N·m of internal tibial torque and 10 N·m of valgus torque.
  
  
  RESULTS
  Medial meniscus posterior horn longitudinal tears in ACL-deficient knees resulted in a significant increase in anterior-posterior tibial translation at all flexion angles except 90° (P < .05). An MMPH repair in an ACL-deficient knee showed a significant decrease in anterior-posterior tibial translation at all flexion angles except 60° compared with the ACL-deficient/MMPH tear state (P < .05). The total anterior-posterior translation of the ACL-deficient/MMPH repaired knee was not significantly increased compared with the ACL (only)-deficient knee but was increased compared with the ACL-intact knee (P > .05). A total medial meniscectomy in an ACL-deficient knee did not increase the anterior-posterior tibial translation significantly compared with MMPH tears in ACL-deficient knees at all flexion angles (P > .05). In a combined rotatory load, tibial rotation after MMPH tears or a total medial meniscectomy in an ACL-deficient knee were not affected significantly at all flexion angles.
  
  
  CONCLUSIONS
  This study shows that an MMPH longitudinal tear in an ACL-deficient knee alters the knee kinematics, particularly the anterior-posterior tibial translation. MMPH repair significantly improved anterior-posterior tibial translation in ACL-deficient knees.
  
  
  CONCLUSIONS
  These findings may help improve the treatment of patients with ACL and MMPH longitudinal tear by suggesting that the medial meniscal repairs should be performed for greater longevity when combined with an ACL reconstruction.
authors.affiliation: Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea.
authors.forename: Jin Hwan
authors.initials: JH
authors.lastname: Ahn
authors.forename: Tae Soo
authors.initials: TS
authors.lastname: Bae
authors.forename: Ki-Ser
authors.initials: KS
authors.lastname: Kang
authors.forename: Soo Yong
authors.initials: SY
authors.lastname: Kang
authors.forename: Sang Hak
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D016118:Anterior Cruciate Ligament / Q000502:physiology; D000070598:Anterior Cruciate Ligament Injuries; D001696:Biomechanical Phenomena / Q000502:physiology; D002102:Cadaver; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology*; D007718:Knee Injuries / Q000503:physiopathology*; D008297:Male; D008592:Menisci, Tibial / Q000502:physiology; D008875:Middle Aged; D000070600:Tibial Meniscus Injuries; D019415:Torque