Arthroscopic studies of variants of the anterior horn of the medial meniscus

The objective of this study was to arthroscopically analyse the morphology and dynamics of variants of the anterior horn of the medial meniscus of the knee (VAMM) and to then consider the pathological significance of these variants. VAMM was defined as knees in which the anterior horn of the medial meniscus is not attached to the tibia. Between April 1992 and March 1995, arthroscopy was performed on 953 knees of 903 patients. At the time of this examination, observation and probing were performed to determine the condition of the synovium, the synovial plica, the cartilage in all compartments, the meniscus, the cruciate ligaments, and the popliteal tendon. In particular, detailed examination was made of the anterior horn of the medial meniscus with regard to the point of insertion to the tibia and the degree of movement in knee flexion/ extension. Cases of VAMM diagnosed on the basis of the arthroscopic findings were classified into the following four categories: the ACL (anterior cruciate ligament) type, where the anterior horn of the medial meniscus was attached to the ACL; the transverse ligament type, where the anterior horn of the medial meniscus was attached to the transverse ligament; the coronary ligament type, where the anterior horn of the medial meniscus was attached to the coronary ligament; and the infrapatellar fold type, where the anterior horn of the medial meniscus was attached to the infrapatellar synovial fold. These patients were then analyzed with regard to the arthroscopic findings and the intra-articular lesions other than VAMM. In 98 (10.9%) of the total patients, 103 knees were classified as VAMM. Classification of those 103 knees using the above criteria showed 39 ACL type knees, 51 transverse ligament type knees, 11 coronary ligament type knees, and 2 infrapatellar fold type knees. The arthroscopic findings indicated that the anterior horn of the medial meniscus was not attached directly to the tibia in any of these knees. Probing and flexion/extension of the knee revealed hypermobility at the anterior horn of the medial meniscus. In this study, anterior knee pain syndrome was diagnosed in 12 (11.7%) of the 103 VAMM knees. In addition, there was no clear history of trauma in 20 of 23 knees found to have an isolated medial meniscus tear. In these cases, even detailed arthroscopic observation proved the causes of the symptoms or injury. On the basis of these findings, we surmised that the anterior portion shows hypermobility at the time of flexion/extension of the knee, regardless of the type of VAMM. In this study, we discussed the possibility that the existence of VAMM may become the cause of pain or injury to the meniscus.     

半月板撕裂和切除对前交叉韧带断裂力学稳定性的影响

目的探讨半月板对前交叉韧带断裂及重建术后胫骨前向稳定性的影响。 方法收集2017年1月至2018年10月期间前交叉韧带重建患者,排除前交叉韧带部分断裂和多发韧带损伤病例。所有不稳定半月板撕裂均行半月板部分切除术,根据半月板损伤部位及程度进行分组。采用KT-1000测量术前、术后3个月和6个月的胫骨前平移量(ATT)。组间对照采用独立样本t检验。 结果共纳入158例前交叉韧带断裂患者,其中半月板正常组61例,内侧半月板后角撕裂组49例(19例为撕脱<总宽度40%;30例为撕脱≥总宽度40%);外侧半月板撕裂组35例(12例为撕脱<总宽度40%;23例为撕脱≥总宽度40%);内侧半月板前角或体部撕裂组13例(6例为撕脱<总宽度40%;7例为撕脱≥总宽度40%)。术前内侧半月板后角撕裂≥总宽度40%患者的胫骨前平移量较半月板正常患者明显增加,差异有统计学意义(t＝12.141,P<0.01)。术后3个月及6个月,各个半月板撕裂组的ATT值与半月板正常患者相比均无差异(P >0.05)。 结论内侧半月板后角撕裂与前交叉韧带断裂可增加膝关节的不稳定性,半月板部分切除术对前交叉韧带重建术后患者的膝关节稳定性无影响。     

膝关节骨关节炎内侧半月板突出的临床意义

目的 探讨膝关节骨关节炎患者内侧半月板突出的病因及影响.方法 选取2011年1月至2012年3月诊断为膝关节退行性骨关节炎并经MRI确认有内侧半月板突出的60例患者为半月板突出组,无突出的60例为对照组.在MRI上测量内侧半月板突出距离、胫股角,分析突出组胫股角与突出距离的相关性,比较两组膝内翻、内侧半月板及胫股关节软骨损伤的发生率,分析内侧半月板突出对半月板损伤、膝内翻对半月板突出的影响.结果 突出组:半月板突出距离平均(8.30±1.79) mm;60例有膝内翻,胫股角平均179.0°±2.2°;内侧半月板损伤发生率:前角50.0％ (30/60),体部93.3％ (56/60),后角93.3％ (56/60);内侧半月板后角根部撕裂14例,发生率23.3％(14/60);胫股内侧关节软骨退变发生率:胫骨内侧平台100％(60/60),股骨内髁100％(60/60);胫股角与内侧半月板突出距离呈负相关.对照组:内侧半月板超出胫骨内侧平台边缘的距离平均(0.57±0.80) mm;4例膝内翻;内侧半月板损伤发生率:前角0,体部16.7％(10/60),后角70.0％ (42/60);无内侧半月板后角根部撕裂;胫股内侧关节软骨退变发生率:胫骨内侧平台26.7％(16/60),股骨内髁30.0％ (18/60).半月板突出组与对照组半月板损伤比值比为6.0、膝内翻例数比值比为15.0.半月板突出组内侧半月板各部位及胫股内侧关节软骨损伤的发生率和严重程度高于对照组.结论 膝内翻可能是内侧半月板突出的原因之一,内侧半月板突出显著增加半月板损伤的发生率,其对膝胫股内侧关节骨关节炎的发生、发展有重要影响.     

The anatomy of tibial eminence fractures: arthroscopic observations following failed closed reduction

BACKGROUND: Failed manipulative reduction of avulsion fractures of the tibial insertion of the anterior cruciate ligament has been attributed to interposition of soft tissues, particularly the anterior horn of the medial meniscus. The objectives of the present report were (1) to show that the failure to reduce Meyers and McKeever type-III tibial eminence fractures was not due to interposition of soft tissues and (2) to discuss the relevance of the finding that the anterior third of the lateral meniscus was attached to the avulsed anterior cruciate ligament insertion site in all patients studied. METHODS: Twelve patients who had had a failed manipulative reduction of a type-III tibial eminence fracture underwent arthroscopic reduction and fixation of the avulsed fragment. RESULTS: A number of consistent findings were noted. The avulsed intercondylar eminence was displaced superiorly into the intercondylar notch. Attached to this fragment was not only the anterior cruciate ligament, but also, in all cases, the anterior horn of the lateral meniscus. The anterior third of the lateral meniscus had been torn from its tibial attachment and displaced together with the osseous fragment into the intercondylar notch. No interposition of bone or soft tissue was observed. Reduction of the osseous fragment was facilitated by traction on, or sutures passed around, the anterior horn of the lateral meniscus. Standard fixation methods were utilized. CONCLUSIONS: The concept that avulsion fractures of the tibial insertion of the anterior cruciate ligament cannot be reduced by manipulation because of soft-tissue interposition was not supported by the findings of the present study. The attachment of the anterior horn of the lateral meniscus to the avulsed tibial insertion of the anterior cruciate ligament may not be an irrelevant incidental finding. The observation that the displaced osseous fragment was attached simultaneously to the anterior cruciate ligament and to the anterior horn of the lateral meniscus, both pulling in different directions, may explain why type-III tibial eminence fractures are irreducible by manipulation.     

Arthroscopic Pullout Repair of a Complete Radial Tear of the Tibial Attachment Site of the Medial Meniscus Posterior Horn

We developed an effective arthroscopic pullout technique for repairing complete radial tears of the tibial attachment site of the medial meniscus posterior horn (MMPH). In our technique, the torn meniscus is reattached to the tibial plateau immediately medial or anteromedial to the posterior cruciate ligament (PCL) using two No. 2 Ethibond sutures (Ethicon, Somerville, NJ). After a complete radial tear of the tibial attachment site of the MMPH and its reparability were confirmed, using a Caspari suture loaded with a suture shuttle, one No. 2 Ethibond suture is placed through the meniscus, through the red-red zone, 3 to 5 mm medial to the torn edge of the MMPH, and the other is passed through the meniscocapsular junction 3 to 5 mm medial to the torn edge of the meniscus. Then, a tibial tunnel, 5-mm in diameter, is made from the anteromedial aspect of the proximal tibia to the previously prepared tibial plateau, immediately medial or anteromedial to the PCL, and the two No. 2 Ethibond sutures are pulled out through the tibial tunnel and then fixed to the proximal tibia using a 3.5-mm cortical screw and washer. Firm reattachment of the torn meniscus was confirmed arthroscopically.     

前十字韧带断裂继发半月板损害的临床研究

目的研究前十字韧带(anteriorcruciateligament,ACL)断裂对半月板的影响。方法回顾分析1984年12月～1999年12月间收治的419例ACL断裂患者半月板的损伤情况及其与软骨损伤的关系。结果外侧半月板的损伤率随病程增加无显著变化,而内侧半月板的损伤率随病程增加显著增加,由急性期的31.1%增至亚慢性期的48.2%(P<0.01),又增至慢性期的78.8%(P<0.001)。内侧半月板后角损伤率较前角高,差异有显著性意义(P<0.05)。损伤形态以纵裂最常见,随着病程的增加,半月板损伤也越发复杂。内侧半月板损伤患者的内髁软骨损伤的发生率要高于内侧半月板正常者的内髁软骨损伤发生率,但差异无显著性意义(P>0.05);而外侧半月板损伤患者的外髁软骨损伤的发生率却显著高于外侧半月板正常者,差异有非常显著性意义(P<0.01)。结论ACL断裂可伴发和继发半月板的损害,ACL断裂时伴发的多为外侧半月板的损伤,而继发的半月板损害却以内侧为重。内髁软骨损害主要由股胫关节前后向不稳、异常活动增加造成,而与内侧半月板的损伤关系不大。     

一种新发现半月板损伤类型的命名、定义及临床研究

目的发现一种新的半月板损伤类型,命名为纤维松散型半月板撕裂,提出定义并进行临床研究。方法纳入自2012-01—2014-06符合标准的1 008例(1 016膝)因各种原因接受膝关节镜手术的患者,共发现纤维松散型半月板撕裂23例,全部位于外侧半月板前角,其中7例合并半月板囊肿。16例未合并半月板囊肿的患者予以半月板边缘部分修整后(盘状半月板予以成形)由外向内用爱惜邦2号线捆扎缝合。7例合并半月板囊肿患者行外侧半月板前角大部切除术,但尽量保存体部及后角的完整性。结果 1 008例中发现纤维松散型半月板撕裂23例,发生率为2.3%。纤维松散型撕裂是外侧半月板前角特有的损伤类型,而且是常见的损伤类型(35.9%)。22例获得随访13~38个月,平均18.8个月。末次随访时膝关节功能Lysholm评分、IKDC评分较术前明显增加,差异有统计学意义(P0.05)。7例并发半月板囊肿者末次随访时均未复发。结论外侧半月板前角的环状纤维与体部和后角的均匀分布不同,聚集成束,长期的超载负荷使环状纤维束之间松散分离,形成独特的纤维松散型损伤。纤维松散型撕裂是外侧半月板前角常见的损伤类型,也与半月板囊肿多发于外侧半月板前角密切相关。     

膝关节外侧半月板假撕裂MRI征象分析及临床意义

目的:明确板股韧带及膝横韧带所致外侧半月板假撕裂的发生机制,探讨外侧半月板假撕裂与真撕裂的鉴别方法。方法:对自2012年6月至2014年2月间72例(左膝44例,右膝28例)经关节镜证实的无外侧半月板撕裂的膝关节进行矢状及冠状位MR扫描,其中男41例,女31例;年龄25～61岁,平均33.7岁。观察板股韧带及膝横韧带的MRI表现。结果:膝横韧带与外侧半月板前角及其中央腱性附着部之间以脂肪组织分隔,在MRI矢状像上,可见脂肪组织在膝横韧带与外侧半月板前角之间形成的线样稍高信号裂隙,类似外侧半月板前角撕裂,称为外侧半月板前角假撕裂。板股韧带在矢状像上表现为位于后交叉韧带前或后方的类圆形或短棒状低信号结构,而在冠状像上表现为自外侧半月板后角至股骨内侧髁外侧面的条带样低信号结构。在矢状像上,板股韧带与外侧半月板后角之间显示出一线样高信号,称为外侧半月板后角假撕裂。膝横韧带在MRI上的出现率约34.7%(25/72),表现为外侧半月板前角假撕裂18例,均表现为外侧半月板形态规则、撕裂线斜行,矢状位图像可连续显示膝横韧带,冠状位图像能显示该韧带的长轴。板股韧带显示率为73.6%(53/72),其中板股前韧带为23.6%(17/72),板股后韧带为70.8%(51/72),两条韧带同时存在为16.7%(12/72).表现为外侧半月板后角假撕裂25例,假撕裂仅有两种走行方向,即后下斜行(19/25)或垂直方向(6/25).结论:根据外侧半月板形状、撕裂线方向、观察矢状和冠状位图像,可正确区分外侧半月板的真、假撕裂。     

The relationship between Parson’s tubercle and the insertion of the anterior horn of the medial meniscus

Purpose: The purpose of this investigation was to correlate the anatomic characteristics of the third intercondylar tubercle of Parsons (TITP) with the insertional variations of the anterior horn of the medial meniscus using precise measurements in an anatomic cadaver study. Our hypothesis was that the height of the TITP would correlate with the degree of inferior insertion of the medial meniscus. Type of Study: A cadaver study using a convenience sample. Methods: Twenty unpaired proximal tibia specimens without advanced arthritis were analyzed with a coordinate measuring machine using a 0.479-mm diameter probe. A reference plane was created using 3 reproducible points on the tibial surface. Measurements from the TITP included another reference plane through its base, which was used to calculate its absolute height. The locations of the anterior- and inferior-most insertional points of the anterior horn of the medial meniscus were also determined. Correlations between the height of the TITP and age were also made. Results: The overall height of the TITP was found to correlate with the degree of inferior insertion of the anterior horn of the medial meniscus (r = .52, P = .019). No correlation was found with the anterior placement of the meniscus (r = .12, P = .629) or with the age of the specimen (r = .14, P = .592). Conclusions: This absolute height of the TITP correlates with the inferior location of the insertion of the anterior horn of the medial meniscus. This association suggests a developmental relationship between 2 anatomic structures within the knee.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 7 (September), 2001: pp 737–740     

Entrapment of the medial meniscus in a fracture of the tibial eminence

Fracture of the intercondylar eminence of the tibia is unusual in adults. Long-term morbidity is uncommon. This is a case in which the anterior horn of the medial meniscus became entrapped in the fracture site after non-operative treatment of a completely displaced fracture, causing persistent medial knee pain. Arthroscopic release of the entrapped meniscus provided excellent relief of symptoms.     

Arthroscopic resection of a bucket handle tear of the meniscus: a technical note

Arthroscopic resection of bucket handle tears of the meniscus is difficult owing to the obstructed view of the posterior horn. It often requires an additional portal for access or additional tools. We describe a technique involving conventional tools including grasper, shaver, and basket forceps. No additional portal is required. The basket forceps are used to cut the anterior attachment of the tear, and the bucket handle is shaved to a suitable size. The grasper is then used to hold the remaining meniscus and move it to the posterior space. The posterior corner of the meniscus is then turned over so that its posterior horn can be seen and accessible for cutting. This technique is primarily for medial meniscectomy. For lateral meniscectomy, the conventional technique may suffice, as the lateral compartment can be easily expanded between the femur and tibia.     

Medial and lateral segond fractures in a skeletally immature patient: a radiographic marker for the multiply injured knee

Marginal fractures of the medial tibial plateau have been reported in the literature as a secondary type of Segond fracture. Some reports described this entity in the setting of combined injuries such as root avulsions of the medial meniscus, complete disruption of the posterior cruciate ligament (PCL), partial tear of the anterior cruciate ligament (ACL), and tears of the medial meniscus and medial collateral ligament. It has been postulated that medial marginal fractures are secondary to compression of the medial aspect of the femoral condyle and tibial plateau with a corresponding posterolateral corner injury. However, this mechanism of injury may not always be as straightforward.This article presents a case of an alternate injury pattern in a skeletally immature patient. A 16-year-old boy sustained a varus force and twisting injury to his knee, resulting in radiographic evidence of multiple avulsion fractures of the knee, including a fibular epiphyseal avulsion fracture and medial and lateral Segond fractures. Usually, the avulsion fractures serve as markers for significant ligamentous injuries in adult patients, but our patient had minimal injury to the PCL, ACL, and posterolateral corner. Further physical examination and imaging studies revealed an anterior horn root avulsion, meniscocapsular separation, and anterior cortical rim fracture. A combination of imaging modalities helped us further characterize the injury pattern to devise the optimal surgical plan, especially the fixation of the anterior cortical fracture of the tibia.     

经胫骨隧道悬吊固定治疗半月板后根部撕脱损伤

目的观察关节镜下经胫骨隧道拉出悬吊固定技术治疗半月板后根部撕脱损伤的临床效果。 方法自2014年9月至2017年12月,对20例前交叉韧带损伤伴随半月板后根部撕脱损伤的患者,在前交叉韧带单束重建的同时采用关节镜下经胫骨隧道拉出悬吊固定技术修复半月板后根部撕脱损伤。纳入前交叉韧带损伤伴随半月板后根部撕脱损伤的患者,排除术前下肢力线异常者及合并软骨损伤者。术前和术后1年时通过Lysholm评分和Tegner评分对患者膝关节功能进行评估,并通过磁共振(MR)观察术后半月板后根部撕脱损伤愈合情况。定量资料比较采用配对样本t检验。 结果所有患者均进行超过1年的随访,患者术后1年随访时Lysholm评分及Tegner评分较术前均有显著提高(t＝7.98、5.55,均为P<0.05);且MR观察未发现半月板后根部再撕裂或半月板体部外凸。 结论关节镜下经胫骨隧道拉出悬吊固定技术可将半月板后根部撕脱复位并稳定固定于其解剖止点区域,从而维持半月板的环状结构以期最大程度恢复膝关节的功能,短期临床效果良好。     

关节镜下建立髁间窝通道治疗内侧半月板后角复杂破裂

目的 :探讨在关节镜下建立髁间窝通道并经该通道治疗内侧半月板后角复杂破裂。方法 :对127例经过髁间窝通道施行了半月板部分切除成形术的骨关节炎病例进行分析总结。127例患者均存在内侧半月板后角复杂裂,男24例,女103例;年龄45~78岁,平均67岁;127例中有112例通过3切口(常规前内侧切口、前外侧切口、高位前外侧切口)顺利完成内侧半月板后角部分切除成形术,有15例通过4切口(常规前内侧切口、前外侧切口、高位前外侧切口、后内侧切口)来完成手术。从4个方面进行评价:该方法对半月板后角部位能否全面便利观察、器械能否便利抵达靶部位、对相邻关节软骨的损伤情况和手术时间(处理半月板的时间)。结果:所有病例的半月板后角后根都能被全面清晰观察,器械都能便利地抵达靶部位,无软骨的医源性破坏发生,3切口情况下内侧半月板后角部位部分切除成形术的时间为5~10 min,4切口的时间为10~30 min。结论:在关节镜下建立髁间窝通道并经此通道治疗内侧半月板后角复杂破裂,方便快捷,最大程度减少了对关节软骨的医源性损伤。     

Bone plug versus suture fixation of the posterior horn in medial meniscalallograft transplantation: a biomechanical study

This study was performed to determine if a meniscal al- lograft with attached bone plug and suture offers superior ixation when compared to allograft afixed with suture alone through a bony tunnel. Seven pairs of human cadaver proximal tibia specimens were obtained. The specimens were then randomly assigned to either Group 1 (suture alone) or Group 2 (bone plug plus suture). All Group 1 specimens had the meniscus detached at the bony insertion of the anterior and posterior horns, with two No. 2 Ethibond sutures placed at the posterior root insertion. All Group 2 specimens had a posterior horn with a bone plug and two No. 2 Ethibond sutures. Both groups had their respective sutures passed through a 7 mm tibial tunnel and secured over a screw and post on the proximal tibia. The specimens were then loaded to failure. The mean failure load for Group 1 was 111.8 N (SD: 21 N) and for Group 2 was 112 N (SD: 32 N). Based on the Wilcoxon Rank-Sum analysis, the two groups were not signiicantly different. This study demonstrated no difference in the mean pullout strength of medial meniscal allograft posterior horn ixation between the two groups. This biome- chanical cadaveric study demonstrated that it may not be necessary to use an attached bone plug for medial meniscal transplant ixation, as using suture alone will sufice. The choice of using suture alone for the posterior horn meniscal attachment eases the technique of surgery when compared to using a bone plug plus suture.     

Dislocating anterior horn of the medial meniscus

Dislocating anterior horn of the medial meniscus was found in 15 knees of 13 patients during arthroscopic examinations done between 1992 and 1995. All of them were available for follow-up evaluation (4 by telephone). There were 11 men and 2 women (average age, 28 years; range, 17 to 49 years). Nine knees had a history of trauma. Only 1 knee had had trauma in two bilateral cases. Duration of symptoms was an average of 3.3 years (range, 3 months to 10 years). The knees were stable clinically. Arthroscopy revealed associated lesions in 13 knees; hypertrophic medial plicae, meniscal, chondral and anterior cruciate ligament (ACL) lesions predominated. Three knees had unusually hypertrophic ligamentum mucosum. Eleven of 13 knees had more than one associated lesions. Only 2 knees (2 patients) had isolated dislocating anterior horn of the medial meniscus. Only the associated lesions were treated (except for ACL lesions) and dislocating anterior horns of the medial menisci were left alone. Follow-up averaged 21 months (7 to 40 months). At follow-up, 11 knees were graded as excellent, 3 as good, and 1 as fair according to the Lysholm scale. Eight knees had minor symptoms and 6 were asymptomatic; no improvement was noted in 1 knee. Overall, 12 patients (14 knees) were satisfied with their treatment. Dislocating anterior horn of the medial meniscus is a normal anatomic variant with little or no clinical significance. When seen during arthroscopy, a significant lesion should be looked for. It is an incidental finding and should be left alone.Arthroscopy 1998 Apr;14(3):246-9     

Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL double-bundle reconstruction: technical note of a transosseous fixation using the tibial PL tunnel

According to our observation in ACL reconstruction, we find root tears of the posterior horn of the lateral meniscus as a common concomitant injury in ACL-deficient knees. This might be a consequence of initial trauma or of the increased anterior–posterior translation of the tibia and an overload impact on the posterior meniscus root in ACL-deficient knees. A tear of the posterior horn of the medial meniscus causes a 25% increase in peak pressure in the medial compartment compared with that found in the intact condition. The repair restores the peak contact pressure to normal (Allaire et al. in J Bone Joint Surg Am 90(9):1922–1931, [2008]). A tear of the posterior horn of the lateral meniscus might have similar consequences. We hypothesize the surgical anatomical reattachment of the root at the tibia helping to restore knee joint kinematics and helping to advance ACL-graft function. This article presents an arthroscopical technique to reattach the posterior meniscus root in combination with ACL double-bundle reconstruction. The procedure uses the tibial PL tunnel to fix the meniscus suture.     

内侧半月板后角放射状撕裂与水平撕裂的危险因素分析

 目的 比较内侧半月板后角放射状撕裂和水平撕裂的危险因素。方法 回顾性分析2011年1月至2012年12月收治的390例应用关节镜治疗的内侧半月板撕裂患者的临床资料,选取其中94例内侧半月板后角放射状撕裂患者及95例内侧半月板后角水平撕裂患者作为研究对象。记录并比较内侧半月板后角放射状撕裂与内侧半月板后角水平撕裂两组患者的年龄、性别、症状持续时间、体重指数、外伤史、胫骨后倾角、膝关节外翻角及Outerbridge软骨分级。采用多因素非条件Logistic回归分析半月板放射状撕裂的危险因素。结果 半月板后角水平撕裂和放射撕裂患者的性别（χ²=9.059,P=0.003）、体重指数（t=-2.549,P=0.012）、膝关节外翻角（t=-5.609,P=0.000）及软骨分级（χ²=42.300,P=0.000）的差异有统计学意义,而外伤史（χ²=0.368,P=0.544）、胫骨后倾角（χ²=1.021,P=0.312）、年龄（t=-1.228,P=0.221）及症状持续时间（t=0.272,P=0.786）的差异无统计学意义。多因素分析结果显示外翻角（Or=12.581,P=0.001）、年龄（Or=0.875,P=0.026）及Outerbridge软骨分级Ⅰ~Ⅳ级（Or=33.790、15.558、39.891、91.041,P=0.000）为半月板放射状撕裂的危险因素。结论 半月板后角撕裂在老年骨关节炎患者中的发生率较高,内侧半月板后角放射状撕裂与水平撕裂比较,更容易发生在膝关节内翻、软骨退变严重的老年患者中。     

Anatomical relationship between insertion sites,tunnel placement,and lateral meniscus anterior horn injury during single and double bundle anterior cruciate ligament reconstructions: A comparative macroscopic and histopathological evaluation in cadavers

PurposeThe influence of tunnel extension outside the anatomical anterior cruciate ligament (ACL) insertion in single-bundle (SB) or double-bundle (DB) ACL reconstruction is unclear. This study aimed to investigate the anatomical relationship between ACL insertion and tunnel extension in SB and DB ACL reconstruction, and the impact of tibial tunnel extension to the insertion of anterior horn of lateral meniscus in terms of injury.MethodsForty-six paired cadaver knees (mean age, 82.7 ± 10.7 years) were used. Right and left knees were used for SB (10 mm) and DB tunnel reaming (6 mm for the anteromedial and posterolateral bundles). Tibial and femoral tunnels were created to aim at the center of the ACL insertion by arthroscopic visualization. The relationship between tunnel extension and ACL insertion was evaluated macroscopically, and there ratio in two groups were compared by chi-square test. Further, the relative risk for meniscus injury based on tunnel placement was estimated. Coronal section of tibia and parallel section to Blumensaat line in femur were prepared to evaluate the relationship among tunnel position, ACL insertion, and anterior horn of the meniscus histologically.ResultsTibial tunnel extension out of the ACL insertion was observed macroscopically in 9 (39.1%) knees of the SB group, and 3 (13.0%) of the DB group (p = 0.045). In femoral tunnels, extension out of the ACL insertion was seen in 8 (34.8%) knees of the SB group and 1 (4.3%) of the DB group (p = 0.011). Partial injuries of the lateral meniscus anterior horn (LMAH) were observed in 5 (21.7%) knees of the SB group and 1 (4.3%) knee of the DB group (p = 0.091). The relative risk for LMAH injury was calculated as 5.0 (odds ratio, 6.1). Microscopically, SB tunnels appeared to expand out of ACL insertion, both in the femur and tibia.ConclusionsThe incidence of tunnel extension out of the ACL insertion in femur and tibia were higher with SB than with DB reconstruction. Furthermore, injury rate of the LMAH in the DB group was lower.