ASSOCIATION OF MEDIAL MENISCAL TEARS - PowerPoint Presentation

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ASSOCIATION OF MEDIAL MENISCAL TEARS AND ACL RUPTURE : AN ANATOMIC PREDISPOSITION ?

E. Servien, MD PhD, professor in orthopaedic surgery, S. Lustig, P. Neyret, R. GaillardACL Study Group 2016

MM ACUTE TEARS + ACL « ACUTE » RUPTUREFor the same traumatic event

= FREQUENT ASSOCIATION +++=> 39.6% to 68% in literatureMeniscal Injuries Associated With Acute Anterior Cruciate Ligament Tears in Alpine Skiers

, Duncan et al.Epidemiology of meniscal injury associated with

ACL tears in young athletes, Kilcoyne et al.Patterns of

meniscal injury

associated with acute anterior cruciate ligament

injury in skiers, Paletta et al.

Bone Contusion and Associated Meniscal and Medial Collateral Ligament Injury in Patients

with

Anterior Cruciate Ligament Rupture, Yoon et al.

CLINICAL RISK FACTORSMaleContact injury

Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport, Tandogan et al.

ANATOMIC RISK FACTORSNo DATA in litterature

MM ACUTE TEARS + ACL ACUTE RUPTURE

ISOLATED ACL RUPTURE ANATOMIC RISK FACTORSShallow medial tibial plateauSmaller tibial plateau length relative to the

femur (Lateral F-T mismatch)More convex articulating surfaces of the proximal aspect of the tibia and the distal aspect of the femur2010 AJSM : Shallow Medial Tibial Plateau and Steep Medial and Lateral Tibial Slopes New

Risk Factors for Anterior Cruciate Ligament Injuries, Hashemi

et al.2012 JBJS : An Association of Lateral Knee Sagittal Anatomic Factors

with Non-Contact ACL

Injury: Sex or Geometry?, Wahl et al.

HYPOTHESISIs there any anatomic

predisposition for the association of MM tears and ACL rupture ?Acute injuries / For the same traumatic eventCT-scan analysis

Prospective case-control studyInclusion criterias :Primary ACL R

Delay between traumatic event and ACL reconstruction < 6 monthsPost-operative CT-scan with 3D reconstructionExclusion criterias :Uncomplete datas ( ikdc score, ct-scan,

etc …)Previous knee surgery

MATERIAL AND METHODS

2 groupsWithMM tears

WithoutMM tears

26 males

27 females= 53 patients

24 males

12 females

= 36 patients

Traumatic

/ acute

MM

tears

N = 89

WITH

MM tears (N=36)WITHOUTMM tears (N=53)pMean age35 years

30 years0.06Weight (kg)

74700.3

Height (cm)

1731720.4

BMI (kg/m2

)25240.4

Injury

mechanism Sport : 29/36

Home : 2/36 Work : 4/36 Road accident : 1/36 Sport : 45/53

Home : 3/53 Work : 3/53 Road accident : 2/530.5

Mean

delay

between

traumatic

event

and

surgery

3.4

months

3.4

months

0.9

Tegner

activity

score

6.1

6.2

0.9

IKDC score

A : 0/36

B : 3/36

C : 33/36

D : 0/36

A : 0/53

B : 3/53

C : 49/53

D : 1/53

0.6

LM

tears

association

11/36 (31%)

15/53(28%)

0.7

LAPFE : Antero-Posterior maximal Length of the Lateral

Femoral condyleLAPTE : Antero-Posterior maximal Length of the Lateral Tibial plateauVFE : maximal Vertical of the Lateral Femoral condyleVTE : maximal Vertical of the Lateral Tibial plateauTDM

measurements – lateral part of the knee

LAPFI : Antero-Posterior maximal Length of the Medial Femoral condyleLAPTI : Antero-Posterior maximal Length of the Medial

Tibial plateauVFI : maximal Vertical of the Medial Femoral condyleVTI : maximal Vertical of the Medial Tibial plateauTDM measurements – medial part of the knee

RLE : Length Lateral Ratio = LAPFE / LAPTERLI : Length Medial Ratio = LAPFI / LAPTI

CFE : Lateral Femoral condyle Convexity = LAPFE / VFECFI : Medial Femoral condyle Convexity = LAPFI / VFICTE : Lateral Tibial plateau Convexity = LAPTE / VTE

CTI : Medial Tibial plateau Concavity = LAPTI / VTI

Ratios

evaluation

Femoral

/ Tibial

Lenght

Ratio

Femoral

condyle

Convexity

Tibial plateau

Convexity

/

Concavity

Only ratios analysis +++To avoid measurement error from the CT-scan software

To have comparable datasComparison :Groups with and without MM tearsMale and female groupsRESULTS

FEMALE

(N=39)MALE(N=50)pRLE : Length Lateral Ratio 2.12.10.4

RLI : Length Medial Ratio

1.61.60.4

CFE : Lateral

Femoral condyle Convexity

3.23.0

0.1CFI : Medial Femoral condyle

Convexity

2.92.9

0.4CTE : Lateral Tibial plateau Convexity

12.417.8

0.04

CTI :

Medial

Tibial plateau

Concavity

15

14.9

0.5

=>

Female

anatomic

characteristics

:

Smaller

CTE =

I

ncreasing

convexity

of the

lateral

tibial plateau

Same

conclusion in

study

of

Wahl et al.

RESULTS

WITH

MM tears (N=36)WITHOUTMM tears (N=53)pRLE : Length Lateral Ratio 2.14

2.130.4RLI : Length

Medial Ratio 1.631.56

0.04

CFE : Lateral

Femoral condyle

Convexity 3.223.040.2

CFI :

Medial Femoral condyle

Convexity 2.912.960.2

CTE : Lateral Tibial plateau Convexity 18.86

14.55

0.2

CTI :

Medial

Tibial plateau

Concavity

15.74

14.49

0.1

RESULTS

=> Smaller medial tibial plateau length relative to the medial

femoral condyle length= MM tears risk factor +++ in association with acl ruptureIncreasing contact force pressure on the meniscus in rotation knee movement

MM

tears

ACL rupture : rotation instability +++Increasing potential rotation knee movementRotation knee

movement : MM tears risk factorChronic ACL rupture = MM tears +++Increasing contact force pressure on meniscus : meniscus tears risk factorMale and contact sport = MM tears risk factors +++

=> Smaller tibia relative to the femur= R

isk factor of associated MM tears

in acute ACL rupture

=> Comparable to other studies about isolated MM tears anatomic risk factors :

2010 : Cam impingement of the posterior femoral condyle in medial meniscal tears, Suganuma et al. => Smaller tibial plateau length

relative to the femur ?2012 : The potential

effect of anatomic relationship between the femur and the tibia on

medial meniscus

tears, Bozkurt et al.

=> Medial

femoro-tibial incongruence ?

ISOLATED MM TEARS ANATOMIC RISK FACTORSMedial femoro-tibial incongruence ??Smaller tibial plateau length relative to the

femur ??=> No evidence based medicine…2010 : Cam impingement of the posterior femoral condyle in medial meniscal tears, Suganuma et al

.2012 : The potential effect of anatomic relationship

between the femur and the tibia on medial meniscus tears,

Bozkurt et al.

Preliminary study… Correlation with IKDC score, pivot shift, etc....Is there also an anatomic risk factor for LM tears

? Analysis on 900 ct-scanCONCLUSION

Smaller medial tibial plateau length relative to the medial femoral condyle length

is a risk factor of MM tears +++ associated with ACL ruptureIncreasing contact force pressure on the MM

Contact force pressure = risk factor of MM tears +++

CONCLUSION

Thank

youThank

you