- See:
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meniscal injury
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anterior cruciate ligament:
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evaluation of ACL injuries:
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bone patellar bone reconstruction:
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hamstring reconstruction:
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allograft reconstruction:
- Discussion:
- note that the combination of ACL tear and meniscal tear is especially likely to contribute to instability, and early osteo-arthritis;
- ACL tears combined w/ medial meniscal tears result in more anterior translation than lateral meniscal tears;
- ACL reconstruction allows protection of the meniscal repair, and some authors feel that a repairable meniscus
tear is in itself an indication for ACL reconstruction (when a ACL tear is present);
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menisectomy in the ACL deficient knee:
- menisectomy in the ACL deficient knee may lead to a significant increase in laxity;
- partial menisectomy may increase peak loads upto 65% whereas total meniscectomy may increase peak loads upto 235%;
- the radiographic consequences of total menisectomy have been characterized by Fairbank and include: joint space narrowing, squaring
of the condyle, and ridge formation;
- references:
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Meniscectomy and repair in the anterior cruciate ligament-deficient patient.
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Arthroscopic meniscectomy in the anterior cruciate ligament-deficient knee.
Hawley ST, Warren RF:
Arthroscopy 1987;3:59-65.
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Arthroscopic partial meniscectomy in the anterior cruciate deficient knee. Aglietti P, Buzzi R, Bassi PB:
Am J Sports Med 1988;16:597-602.
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Results of meniscectomy in the knee with anterior cruciate ligament deficiency.
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Results of partial meniscectomy related to the state of the anterior cruciate ligament. Review at 20 to 35 years.
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meniscal repair in the ACL deficient knee:
- see
techniques for meniscal repair;
- the best results in meniscal repair occur w/ concomitant ACL reconstruction;
- indications:
- if tear is w/in 3 mm of the periphery, it is considered vascular; (see
vascular anatomy)
- area 3-5 mm from periphery is grey zone, & > 5 mm from periphery is considered avascular;
- unstable tears or tears within vascular zone that are > 7 mm are repairable;
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controversies: how to handle the locked bucket handle meniscal tear w/ concomitant ACL tear?
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Shelbourne KD. and Johnson GE. 1993, advocate staged treatment of concomitant
bucket handle and ACL injuries;
- theoretical advantages of staged repair and reconstruction:
- more aggressive use of repair rather than removal of a displaced torn meniscus;
- prevention of problems in regaining range of motion;
- allows a second look to judge the success of meniscal repair;
- allows time for the patient to prepare for ACL reconstruction;
- references:
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Locked bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency.
Shelbourne KD.
Johnson GE.
American Journal of Sports Medicine.
21(6):779-82; discussion 782, 1993
Nov-Dec.
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Arthroscopic evaluation of meniscal repairs after anterior cruciate ligament reconstruction and immediate motion.
MS buseck and FR Noyes.
Am J. Sports Med. Vol 19. 1991. p 489-494.
"Aggressive" nontreatment of lateral meniscal tears seen during anterior cruciate ligament reconstruction.
Treatment of the anterior cruciate ligament-absent knee with associated meniscal tears. Instrumented testing and clinical evaluation of two patient groups.
Double-blind assessment of the value of magnetic resonance imaging in the diagnosis of anterior cruciate and meniscal lesions.
Reconstruction of the anterior cruciate ligament using a torn meniscus.
The role of the meniscus in the anterior-posterior stability of the loaded anterior cruciate-deficient knee. Effects of partial versus total excision.
Meniscal lesions and chronic anterior cruciate ligament deficiency - meniscal tears occuring before and after reconstruction.
RC Bray and Dandy DJ.
JBJS Vol 71-B. 1989. p 128-130.
The natural history of the meniscus in anterior cruciate ligament insufficiency.
Arthroscopic analysis.
GB Irvine and MM Glasgow.
JBJS Vol 74-B.(3) 1992. p 403-405.
Meniscal injury in the ACL deficient knee. A rationale for clinical decision making.
LS Rosenberg and MF Sherman.
Sports Med. Vol 13. 1992. p 423-432.
