Background:

A lateral meniscal (LM) disorder is one factor that causes rotational laxity after anterior cruciate ligament (ACL) reconstruction (ACLR). There are different types of irreparable meniscal disorders, one of which is a massive meniscal defect.

Hypothesis/Purpose:

The purpose of this study was to evaluate the kinematic effects of arthroscopic centralization on an irreparable LM defect. The hypothesis was that arthroscopic centralization for an irreparable LM defect with concomitant ACLR would improve knee rotational stability.

Study Design:

Controlled laboratory study.

Methods:

A total of 14 fresh-frozen human cadaveric knees were tested in 4 states: (1) intact ACL and intact lateral meniscus, (2) reconstructed ACL and intact lateral meniscus, (3) reconstructed ACL and lateral meniscus defect, and (4) reconstructed ACL and centralized lateral meniscus. Anatomic ACLR was performed using an 8 mm–diameter hamstring tendon graft. An LM defect (20% of the anteroposterior length) was created arthroscopically, and arthroscopic centralization was performed. Kinematics were analyzed using a 6 degrees of freedom robotic system under 4 knee loads: (1) an 89.0-N anterior tibial load, (2) a 5.0-N·m external rotation tibial torque, (3) a 5.0-N·m internal rotation tibial torque, and (4) a simulated pivot-shift load with a combined 7.0-N·m valgus and 5.0-N·m internal rotation tibial torque.

Results:

LM centralization reduced anterior tibial translation similar to that of the ACLR intact LM state under anterior tibial loading (~2 mm at 30° of flexion) and showed 40% to 100% of tibial displacement in the 4 knee states under simulated pivot-shift loading. The procedure overconstrained the knee under internal rotation tibial torque and simulated pivot-shift loading.

Conclusion:

Arthroscopic centralization reduced knee laxity after ACLR for a massive LM defect in a cadaveric model.

Clinical Relevance:

In cases involving irreparable LM injuries during ACLR, consideration should be given to arthroscopic centralization for reducing knee laxity. However, the procedure may overconstrain the knee in certain motions.

中文翻译：

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外侧半月板损伤的关节镜下中心化减少前交叉韧带的松弛 - 重建膝

背景：

外侧半月板 (LM) 障碍是导致前交叉韧带 (ACL) 重建 (ACLR) 后旋转松弛的一个因素。有不同类型的无法修复的半月板疾病，其中之一是巨大的半月板缺损。

假设/目的：

本研究的目的是评估关节镜中心化对不可修复的 LM 缺损的运动学影响。假设是对于不可修复的 LM 缺损伴有 ACLR 的关节镜下中心化将改善膝关节旋转稳定性。

学习规划：

受控实验室研究。

方法：

总共 14 个新鲜冷冻的人类尸体膝盖在 4 种状态下进行了测试：（1）完整的 ACL 和完整的外侧半月板，（2）重建的 ACL 和完整的外侧半月板，（3）重建的 ACL 和外侧半月板缺损，以及（4）重建的 ACL 和中央外侧半月板。使用 8 毫米直径的腘绳肌腱移植物进行解剖性 ACLR。在关节镜下制造 LM 缺损（前后长度的 20%），并进行关节镜居中。使用 6 自由度机器人系统在 4 个膝关节负载下分析运动学：(1) 89.0-N 前胫骨负载，(2) 5.0-N·m 外旋胫骨扭矩，(3) 5.0-N·m胫骨内旋扭矩，以及 (4) 模拟枢轴移位负载，结合 7.0-N·m 外翻和 5.0-N·m 内旋胫骨扭矩。

结果：

LM 中心化减少了胫骨前部平移，类似于在胫骨前负荷（屈曲 30 度时~2 毫米）下的 ACLR 完整 LM 状态的前胫骨平移，并在模拟枢轴移位负荷下的 4 种膝关节状态下显示 40% 至 100% 的胫骨位移. 该程序在内旋胫骨扭矩和模拟枢轴移位载荷下过度约束膝盖。

结论：

对于尸体模型中的大量 LM 缺损，关节镜下中心化减少了 ACLR 后的膝关节松弛。

临床相关性：

在 ACLR 期间涉及不可修复的 LM 损伤的情况下，应考虑关节镜下中心化以减少膝关节松弛。然而，该程序可能会在某些运动中过度约束膝盖。