Meniscus Repair Reduces Anterolateral Rotational Instability of the ACL Injured Knee: Quantitative Assessment of the Pivot Shift Phenomenon Using Triaxial Accelerometer
Author(s):
Katakura Mai (Japan)
Katakura Mai (Japan)
Affiliations:
ESSKA Academy. Katakura M. 05/09/18; 209771; P15-418 Topic: Biomechanics
Mai Katakura
Mai Katakura
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Abstract
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Objectives: Recent research has demonstrated that some types of meniscus tear are associated with anterolateral rotational instability (ALRI) of the anterior cruciate ligament (ACL) injured knee, which can be revealed by the positive pivot shift test. However information regarding effects of meniscus repair on ALRI in clinical settings is limited. Triaxial accelerometer is a system that can evaluate the pivot shift phenomenon quantitatively in the clinical settings by measuring the acceleration of the tibia (tibial acceleration) during the pivot shift phenomenon. The purpose of the present study was to investigate the effects of meniscus repair on ALRI in ACL injured patients by evaluating pivot shift phenomenon quantitatively using triaxial accelerometer.

Methods: A retrospective analysis of prospectively collected data was performed. Between August 2016 and August 2017, patients who were scheduled to undergo ACL reconstruction were enrolled in the study. Patients with knee osteoarthritis, concomitant ligament tears or history of injuries in contralateral knees, meniscus injuries which needed resection were excluded, consequently 34 patients (11 males, 23 females, mean age 27 years old) were included. Tibial acceleration during the pivot shift test was measured using the triaxial accelerometer intraoperatively just after arthroscopic evaluation, medial meniscus repair (if present), lateral meniscus repair (if present), and ACL reconstruction. The change of the tibial acceleration before and after each procedure were assessed using paired t-test or repeated measure ANOVA and tukey HSD test. In all analyses, p<0.05 was considered to indicate significance.

Results: Among those 34 included patients, 12 patients presented no meniscus tear and 22 patients had meniscus tear (medial meniscus tear: 5, lateral meniscus tear: 7, both medial and lateral meniscus tears: 10). All of these tears were repaired. In patients without meniscus tear group, tibial acceleration was significantly reduced after ACL reconstruction (4.0±1.1m/s2 to 1.6±0.5 m/s2, p<0.01). In patients with meniscus tear group, tibial acceleration was significantly reduced after both meniscus repair (4.6±2.2 m/s2 to 2.6±0.9 m/s2, p<0.01) and ACL reconstruction (2.6±0.9 m/s2 to 1.4±0.4 m/s2, p<0.01). In additional analysis comparing the effect of medial and lateral meniscus repair separately, both medial and lateral meniscus repair significantly reduced tibial acceleration (p<0.01).

Conclusions: This study revealed that both medial and lateral meniscus repairs in addition to ACL reconstruction significantly contributed to reducing tibial acceleration. This suggests that both medial and lateral menisci have an important role as secondary restraint for the ALRI, thus it is considered important to repair meniscus in order to control ALRI.

Keywords:
anterolateral rotational instability, meniscus, anterior cruciate ligament injury
Objectives: Recent research has demonstrated that some types of meniscus tear are associated with anterolateral rotational instability (ALRI) of the anterior cruciate ligament (ACL) injured knee, which can be revealed by the positive pivot shift test. However information regarding effects of meniscus repair on ALRI in clinical settings is limited. Triaxial accelerometer is a system that can evaluate the pivot shift phenomenon quantitatively in the clinical settings by measuring the acceleration of the tibia (tibial acceleration) during the pivot shift phenomenon. The purpose of the present study was to investigate the effects of meniscus repair on ALRI in ACL injured patients by evaluating pivot shift phenomenon quantitatively using triaxial accelerometer.

Methods: A retrospective analysis of prospectively collected data was performed. Between August 2016 and August 2017, patients who were scheduled to undergo ACL reconstruction were enrolled in the study. Patients with knee osteoarthritis, concomitant ligament tears or history of injuries in contralateral knees, meniscus injuries which needed resection were excluded, consequently 34 patients (11 males, 23 females, mean age 27 years old) were included. Tibial acceleration during the pivot shift test was measured using the triaxial accelerometer intraoperatively just after arthroscopic evaluation, medial meniscus repair (if present), lateral meniscus repair (if present), and ACL reconstruction. The change of the tibial acceleration before and after each procedure were assessed using paired t-test or repeated measure ANOVA and tukey HSD test. In all analyses, p<0.05 was considered to indicate significance.

Results: Among those 34 included patients, 12 patients presented no meniscus tear and 22 patients had meniscus tear (medial meniscus tear: 5, lateral meniscus tear: 7, both medial and lateral meniscus tears: 10). All of these tears were repaired. In patients without meniscus tear group, tibial acceleration was significantly reduced after ACL reconstruction (4.0±1.1m/s2 to 1.6±0.5 m/s2, p<0.01). In patients with meniscus tear group, tibial acceleration was significantly reduced after both meniscus repair (4.6±2.2 m/s2 to 2.6±0.9 m/s2, p<0.01) and ACL reconstruction (2.6±0.9 m/s2 to 1.4±0.4 m/s2, p<0.01). In additional analysis comparing the effect of medial and lateral meniscus repair separately, both medial and lateral meniscus repair significantly reduced tibial acceleration (p<0.01).

Conclusions: This study revealed that both medial and lateral meniscus repairs in addition to ACL reconstruction significantly contributed to reducing tibial acceleration. This suggests that both medial and lateral menisci have an important role as secondary restraint for the ALRI, thus it is considered important to repair meniscus in order to control ALRI.

Keywords:
anterolateral rotational instability, meniscus, anterior cruciate ligament injury
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