TY - JOUR
T1 - Medial Meniscal Extrusion of Greater Than 3 Millimeters on Ultrasound Suggests Combined Medial Meniscotibial Ligament and Posterior Medial Meniscal Root Tears
T2 - A Cadaveric Analysis
AU - Farivar, Daniel
AU - Knapik, Derrick M.
AU - Vadhera, Amar S.
AU - Condron, Nolan B.
AU - Hevesi, Mario
AU - Shewman, Elizabeth F.
AU - Ralls, Michael
AU - White, Gregory M.
AU - Chahla, Jorge
N1 - Publisher Copyright:
© 2023 Arthroscopy Association of North America
PY - 2023/8
Y1 - 2023/8
N2 - Purpose: To evaluate how the meniscotibial ligament (MTL) affects meniscal extrusion (ME) with or without concomitant posterior medial meniscal root (PMMR) tears and to describe how ME varied along the length of meniscus. Methods: ME was measured using ultrasonography in 10 human cadaveric knees in conditions: (1) control, either (2a) isolated MTL sectioning, or (2b) isolated PMMR tear, (3) combined PMMR+MTL sectioning, and (4) PMMR repair. Measurements were obtained 1 cm anterior to the MCL (anterior), over the MCL (middle), and 1 cm posterior to the MCL (posterior) with or without 1,000 N axial loads in 0° and 30° flexion. Results: At 0°, MTL sectioning demonstrated greater middle than anterior (P <.001) and posterior (P <.001) ME, whereas PMMR (P =.0042) and PMMR+MTL (P <.001) sectioning demonstrated greater posterior than anterior ME. At 30°, PMMR (P <.001) and PMMR+MTL (P <.001) sectioning demonstrated greater posterior than anterior ME, and PMMR (P =.0012) and PMMR+MTL (P =.0058) sectioning demonstrated greater posterior than anterior ME. PMMR+MTL sectioning demonstrated greater posterior ME at 30° compared with 0° (P =.0320). MTL sectioning always resulted in greater middle ME (P <.001), in contrast with no middle ME changes following PMMR sectioning. At 0°, PMMR sectioning resulted in greater posterior ME (P <.001), but at 30°, both PMMR and MTL sectioning resulted in greater posterior ME (P <.001). Total ME surpassed 3 mm only when both the MTL and PMMR were sectioned. Conclusions: The MTL and PMMR contribute most to ME when measured posterior to the MCL at 30° of flexion. ME greater than 3 mm is suggestive of combined PMMR + MTL lesions. Clinical Relevance: Overlooked MTL pathology may contribute to persistent ME following PMMR repair. We found isolated MTL tears able to cause 2 to 2.99 mm of ME, but the clinical significance of these magnitudes of extrusion is unclear. The use of ME measurement guidelines with ultrasound may allow for practical MTL and PMMR pathology screening and pre-operative planning.
AB - Purpose: To evaluate how the meniscotibial ligament (MTL) affects meniscal extrusion (ME) with or without concomitant posterior medial meniscal root (PMMR) tears and to describe how ME varied along the length of meniscus. Methods: ME was measured using ultrasonography in 10 human cadaveric knees in conditions: (1) control, either (2a) isolated MTL sectioning, or (2b) isolated PMMR tear, (3) combined PMMR+MTL sectioning, and (4) PMMR repair. Measurements were obtained 1 cm anterior to the MCL (anterior), over the MCL (middle), and 1 cm posterior to the MCL (posterior) with or without 1,000 N axial loads in 0° and 30° flexion. Results: At 0°, MTL sectioning demonstrated greater middle than anterior (P <.001) and posterior (P <.001) ME, whereas PMMR (P =.0042) and PMMR+MTL (P <.001) sectioning demonstrated greater posterior than anterior ME. At 30°, PMMR (P <.001) and PMMR+MTL (P <.001) sectioning demonstrated greater posterior than anterior ME, and PMMR (P =.0012) and PMMR+MTL (P =.0058) sectioning demonstrated greater posterior than anterior ME. PMMR+MTL sectioning demonstrated greater posterior ME at 30° compared with 0° (P =.0320). MTL sectioning always resulted in greater middle ME (P <.001), in contrast with no middle ME changes following PMMR sectioning. At 0°, PMMR sectioning resulted in greater posterior ME (P <.001), but at 30°, both PMMR and MTL sectioning resulted in greater posterior ME (P <.001). Total ME surpassed 3 mm only when both the MTL and PMMR were sectioned. Conclusions: The MTL and PMMR contribute most to ME when measured posterior to the MCL at 30° of flexion. ME greater than 3 mm is suggestive of combined PMMR + MTL lesions. Clinical Relevance: Overlooked MTL pathology may contribute to persistent ME following PMMR repair. We found isolated MTL tears able to cause 2 to 2.99 mm of ME, but the clinical significance of these magnitudes of extrusion is unclear. The use of ME measurement guidelines with ultrasound may allow for practical MTL and PMMR pathology screening and pre-operative planning.
UR - http://www.scopus.com/inward/record.url?scp=85153305002&partnerID=8YFLogxK
U2 - 10.1016/j.arthro.2023.01.104
DO - 10.1016/j.arthro.2023.01.104
M3 - Article
C2 - 36813009
AN - SCOPUS:85153305002
SN - 0749-8063
VL - 39
SP - 1815-1826.e1
JO - Arthroscopy - Journal of Arthroscopic and Related Surgery
JF - Arthroscopy - Journal of Arthroscopic and Related Surgery
IS - 8
ER -