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Gupta R, Phogat V, Khokkhar R, Kapoor A. Medial and Lateral Meniscus Root Tear: Etiopathogenesis and Morphological Pattern in Indian Population. Indian J Orthop 2025; 59:115-120. [PMID: 39735882 PMCID: PMC11680528 DOI: 10.1007/s43465-024-01297-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 11/19/2024] [Indexed: 12/31/2024]
Abstract
Objective This study aims to enhance our understanding of the morphological pattern, causes and pathogenesis of meniscal root injuries in the Indian population. Materials and Methods Sixty-four patients with meniscus root tears were included in the study. The patients were categorized into two groups based on the location of the meniscus tear: Group 1 (n = 41) comprised patients with lateral meniscus root injury (LMRI), and Group 2 (n = 23) included patients with medial meniscus root injury (MMRI). Demographic and patient-specific data, such as age, gender, BMI, history of injury, and injury type, were recorded. All patients underwent surgical treatment, and intraoperative findings (chondral damage grade, type of root injury, associated ligamentous injuries) were documented. Meniscus root tears are further classified into 5 categories depending upon their morphological types. A minimum 12-month follow-up assessed functional outcomes using the Lysholm and IKDC knee scores. Results The mean age for MMRI and LMRI was 50.3 years and 29.4 years, respectively. In the MMRI group, 48% (11/23) were female compared to only 15% (6/41) in the LMRI group. The mean BMI in the MMRI and LMRI groups was 30.1 and 25.4, respectively. Nine patients in MMRI and 4 patients in LMRI group exhibited grade 3 or higher chondral damage. Type 2 meniscus root tear was most common type in both the groups (51% in MMRI vs. 74% in LMRI). Both LMRI and MMRI groups demonstrated significant improvement in functional outcomes. Conclusions Medial meniscus root injuries predominantly occur in the elderly without a significant history of trauma, often associated with a high grade of medial femoral chondral damage, suggesting a degenerative etiology. In contrast, lateral meniscus root injuries tend to occur in younger patients with a notable history of knee injury, indicative of a traumatic etiology for LMRI.
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Affiliation(s)
- Ravi Gupta
- Sports Medicine, Fortis Hospital, Mohali, Punjab India
| | - Varun Phogat
- Sports Medicine, Fortis Hospital, Mohali, Punjab India
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Bai W, Zhang Z, Hong L, Dai W, Meng Q, Shi W, Wang C. Increased anterior tibial subluxation and differences between anterior tibial subluxation in the lateral and medial compartments are associated with failure of primary anterior cruciate ligament reconstruction: A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39162345 DOI: 10.1002/ksa.12428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 07/22/2024] [Accepted: 07/31/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE The purpose of this study is to investigate whether increased anterior tibial subluxation (ATS) and differences between ATS in the lateral and medial compartments (ATSL-M) are associated with primary anterior cruciate ligament (ACL) reconstruction (ACLR) failure. METHODS PubMed, Scopus, Embase and Web of Science were systematically searched from their inception through 21 November 2023. The focus was on comparative studies reporting ATS in patients who experienced primary ACLR failure, in contrast to patients after primary ACLR with no evidence of graft failure. A random-effects model was employed to calculate the overall standardized mean difference between the two groups. RESULTS A total of eight studies involving 963 patients were included in the final review. Three studies (64 cases and 171 controls) measured ATS on radiographs. The failed ACLR group exhibited a significantly increased ATS on radiographs compared to the control group (p < 0.001). Six studies (324 cases and 488 controls) measured lateral ATS on magnetic resonance imaging and five of them (285 cases and 374 controls) also measured medial ATS. The average values of lateral and medial ATS, as well as ATSL-M, were calculated and compared between the two groups. The failed ACLR group demonstrated significantly increased lateral (p < 0.001) and medial ATS (p < 0.001), the average value of lateral and medial ATS (p < 0.001) and ATSL-M (p = 0.039) compared to the control group. CONCLUSION Increased ATS and ATSL-M are associated with primary ACLR failure. The measurement of tibiofemoral position shows promise for its application in preoperative planning and postoperative management of ACLR. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Wenbin Bai
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Zhiyu Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Lejin Hong
- Department of Orthopaedics, Zhangpu Hospital, Zhangzhou, China
| | - Wenli Dai
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Qingyang Meng
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Weili Shi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
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Kim YS, Koo S, Kim JH, Tae J, Wang JH, Ahn JH, Jang KM, Jeon J, Lee DK. Greater Knee Rotatory Instability After Posterior Meniscocapsular Injury Versus Anterolateral Ligament Injury: A Proposed Mechanism of High-Grade Pivot Shift. Orthop J Sports Med 2023; 11:23259671231188712. [PMID: 37693803 PMCID: PMC10486219 DOI: 10.1177/23259671231188712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/24/2023] [Indexed: 09/12/2023] Open
Abstract
Background For anterolateral rotatory instability as a result of secondary soft tissue injuries in anterior cruciate ligament (ACL)-deficient knees, there is increasing interest in secondary stabilizers to prevent internal rotation (IR) of the tibia. Purpose To determine which secondary stabilizer is more important in anterolateral rotatory instability in ACL-deficient knees. Study Design Controlled laboratory study. Methods The lower extremities of 10 fresh-frozen cadavers (20 extremities) without anterior-posterior or rotational instability were included. Matched-pair randomization was performed, with each side per specimen assigned to 1 of 2 groups. In group 1, the ACL was sectioned, followed by the anterolateral ligament (ALL); in group 2, the ACL was sectioned, followed by sequential sectioning of the posterolateral meniscocapsular complex (PLMCC) and posteromedial meniscocapsular complex (PMMCC). The primary outcome was the change in relative tibial IR during a simulated pivot-shift test with 5 N·m of IR torque and 8.9 N of valgus force. The secondary outcomes were the International Knee Documentation Committee grade in the pivot-shift test and the incidence of the grade 3 pivot shift. Results In group 1, compared with baseline, the change in relative tibial IR at 0° of knee flexion was 1.4° (95% CI, -0.1° to 2.9°; P = .052) after ALL release. In group 2, it was 2.5° (95% CI, 0.4° to 4.8°; P = .007) after PLMCC release and 4.1° (95% CI, 0.5° to 7.8°; P = .017) after combined PLMCC and PMMCC release. Combined PLMCC and PMMCC release resulted in greater change of tibial IR with statistical significance at 0°, 15°, and 30° of knee flexion (P = .008, .057, and .004, respectively) compared with ALL release. The incidence of grade 3 pivot shifts was 10% in group 1 and 90% in group 2. Conclusion Posterior meniscocapsular laxity caused an increase in relative tibial IR as much as ALL injury in ACL-deficient knees in our simulated laboratory test, and greater anterolateral rotatory instability occurred with posterior meniscocapsular injury compared with ALL injury. Clinical Relevance Repair of the injured posterior meniscocapsular complex may be an important treatment option for reducing anterolateral rotatory instability in the ACL-deficient knee.
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Affiliation(s)
- Yi-Suk Kim
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungbum Koo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jun Ho Kim
- Department of Orthopedic Surgery, Kyunghee University Hospital at Gangdong, Kyunghee University School of Medicine, Seoul, Republic of Korea
| | - Jungyeun Tae
- Konyang University School of Medicine, Daejeon, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Hwan Ahn
- Department of Orthopaedic Surgery, Saeum Hospital, Seoul, Republic of Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jongmin Jeon
- Department of Orthopedic Surgery, Changwon Samsung Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Do Kyung Lee
- Department of Orthopedic Surgery, Changwon Samsung Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
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Yañez-Diaz R, Roby M, Silvestre R, Zamorano H, Vergara F, Sandoval C, Neira A, Yañez-Rojo C, De la Fuente C. Multiclass Support Vector Machine improves the Pivot-shift grading from Gerdy's acceleration resultant prior to the acute Anterior Cruciate Ligament surgery. Injury 2023:S0020-1383(23)00271-1. [PMID: 37003872 DOI: 10.1016/j.injury.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Rotatory laxity acceleration still lacks objective classification due to interval grading superposition, resulting in a biased pivot shift grading prior to the Anterior Cruciate Ligament (ACL) reconstruction. However, data analysis might help improve data grading in the operative room. Therefore, we described the improvement of the pivot-shift categorization in Gerdy's acceleration under anesthesia prior to ACL surgery using a support vector machine (SVM) classification, surgeon, and literature reference. METHODS Seventy-five patients (aged 30.3 ± 10.2 years, and IKDC 52.0 ± 16.5 points) with acute ACL rupture under anesthesia prior to ACL surgery were analyzed. Patients were graded with pivot-shift sign glide (+), clunk (++), and (+++) gross by senior orthopedic surgeons. At the same time, the tri-axial tibial plateau acceleration was measured. Categorical data were statistically described, and the accelerometry and categorical data were associated (α = 5%). A multiclass SVM kernel with the best accuracy trained by orthopedic surgeons and assisted from literature for missing data was compared with experienced surgeons and literature interval grading. The cubic SVM classifier achieved the best grading. RESULTS The intra-group proportions were different for each grading in the three compared strategies (p < 0.001). The inter-group proportions were different for all comparisons (p < 0.001). There were significant (p < 0.001) associations (Tau: 0.69, -0.28, and -0.50) between the surgeon and SVM, the surgeon and interval grading, and the interval and SVM, respectively. CONCLUSION The multiclass SVM classifier improves the acceleration categorization of the (+), (++), and (+++) pivot shift sign prior to the ACL surgery in agreement with surgeon criteria.
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Affiliation(s)
- Roberto Yañez-Diaz
- Traumatologia, Clinica MEDS, Santiago, Chile; Centro de Innovación, Clinica MEDS, Santiago Chile
| | - Matías Roby
- Traumatologia, Clinica MEDS, Santiago, Chile; Centro de Innovación, Clinica MEDS, Santiago Chile
| | - Rony Silvestre
- Centro de Innovación, Clinica MEDS, Santiago Chile; Carrera de Kinesiologia, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | | | | | - Alejandro Neira
- Escuela de Kinesiologia, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Chile
| | | | - Carlos De la Fuente
- Centro de Innovación, Clinica MEDS, Santiago Chile; Carrera de Kinesiologia, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Applied Neuromechanics Research Group, Universidade Federal do Pampa, Uruguaiana, RS, Brazil.
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Ni QK, Wang XP, Guo Q, Li M, Liu N, Zhang H. High-grade pivot-shift phenomenon after anterior cruciate ligament injury is associated with asymmetry of lateral and medial compartment anterior tibial translation and lateral meniscus posterior horn tears. Knee Surg Sports Traumatol Arthrosc 2022; 30:3700-3707. [PMID: 35460039 DOI: 10.1007/s00167-022-06972-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate whether the high-grade pivot-shift phenomenon is associated with asymmetry of the lateral and medial compartment anterior tibial translation (L-ATT and M-ATT) and lateral meniscus posterior horn (LMPH) tears in anterior cruciate ligament (ACL) injuries. METHODS A retrospective analysis was performed on 192 consecutive patients who had complete ACL injuries between January 2019 and December 2020. Among these, 156 met the inclusion criteria. L-ATT and M-ATT were measured using preoperative weight-bearing magnetic resonance imaging (MRI), and the differences between L-ATT and M-ATT were calculated. Thirty-five patients who demonstrated excessive differences in L-ATT and M-ATT (> 6.0 mm) were regarded as asymmetric (study group), and 36 patients with minimal or no differences in L-ATT and M-ATT (< 3.0 mm) were allocated to the control group. Demographic data, grade of the pivot-shift test, integrality of LMPH, and medial meniscus posterior horn (MMPH) were compared between the groups. Moreover, predictors of high-grade pivot-shift phenomenon, including asymmetry of L-ATT and M-ATT, integrity of LMPH and MMPH, time from injury to surgery, sex, age, and body mass index (BMI) were assessed using multivariable logistic regression analysis. RESULTS The difference between L-ATT and M-ATT in the study group was significantly higher than that in the control group (mean ± SD: 8.4 ± 2.1 mm vs. 1.5 ± 1.0 mm, P < 0.001). A higher proportion of patients with high-grade pivot-shift phenomenon (2 + and 3 +) and LMPH tears were identified in the study group (high-grade pivot-shift phenomenon: 25/35 vs. 13/36, P = 0.003; LMPH tears: 18/35 vs. 5/36, P = 0.001). Additionally, asymmetry of L-ATT, M-ATT (odds ratio 5.8; 95% CI 1.7-19.8; P = 0.005), and LMPH tears (odds ratio 3.8; 95% CI 1.3-11.6; P = 0.018) were found to be good predictors of the high-grade pivot-shift phenomenon after ACL injury, whereas MMPH tears, time from injury to surgery, sex, age, and BMI were not. CONCLUSION In patients with ACL injury, the high-grade pivot-shift phenomenon is associated with asymmetry between L-ATT and M-ATT, and LMPH tears. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Qian-Kun Ni
- Sports Medicine Department, Zhengzhou Orthopedics Hospital, No.58, Long Hai Middle Road, Er Qi District, Zhengzhou, Henan Province, China
| | - Xu-Peng Wang
- Sports Medicine Department, Zhengzhou Orthopedics Hospital, No.58, Long Hai Middle Road, Er Qi District, Zhengzhou, Henan Province, China
| | - Qi Guo
- Sports Medicine Department, Zhengzhou Orthopedics Hospital, No.58, Long Hai Middle Road, Er Qi District, Zhengzhou, Henan Province, China
| | - Ming Li
- Sports Medicine Department, Zhengzhou Orthopedics Hospital, No.58, Long Hai Middle Road, Er Qi District, Zhengzhou, Henan Province, China
| | - Ning Liu
- Sports Medicine Department, Zhengzhou Orthopedics Hospital, No.58, Long Hai Middle Road, Er Qi District, Zhengzhou, Henan Province, China.
| | - Hui Zhang
- Sports Medicine Department, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China.
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