Transcript association of medial meniscal tears and acl acute rupture

ASSOCIATION OF MEDIAL MENISCAL TEARS
AND ACL RUPTURE :
AN ANATOMIC PREDISPOSITION ?
E. Servien, MD PhD, professor in orthopaedic surgery,
S. Lustig, P. Neyret, R. Gaillard
ACL Study Group 2016
MM ACUTE TEARS + ACL « ACUTE » RUPTURE
For the same traumatic event
= FREQUENT ASSOCIATION +++
=>
39.6% to 68% in literature
•
•
•
•
Meniscal 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.
ISOLATED ACL RUPTURE ANATOMIC RISK FACTORS
• Shallow medial tibial plateau
• Smaller 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 femur
• 2010 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
HYPOTHESIS
Is there any anatomic predisposition
for the association of MM tears
and ACL rupture ?
• Acute injuries / For the same traumatic event
• CT-scan analysis
MATERIAL AND METHODS
• Prospective case-control study
• Inclusion criterias :
• Primary ACL R
• Delay between traumatic event and ACL reconstruction < 6 months
• Post-operative CT-scan with 3D reconstruction
• Exclusion criterias :
• Uncomplete datas ( ikdc score, ct-scan, etc …)
• Previous knee surgery
N = 89
2 groups
With
MM tears
Without
MM tears
Traumatic / acute
MM tears
• 24 males
• 26 males
• 12 females
• 27 females
= 36 patients
= 53 patients
WITH
MM tears (N=36)
WITHOUT
MM tears (N=53)
p
35 years
30 years
0.06
Weight (kg)
74
70
0.3
Height (cm)
173
172
0.4
BMI (kg/m2)
25
24
0.4
Mean age
Injury mechanism
Mean delay between
traumatic event and surgery
Sport : 29/36
Home : 2/36
Work : 4/36
Road accident : 1/36
LM tears association
0.5
3.4 months
3.4 months
0.9
6.1
6.2
0.9
Tegner activity score
IKDC score
Sport : 45/53
Home : 3/53
Work : 3/53
Road accident : 2/53
A : 0/36
B : 3/36
C : 33/36
D : 0/36
11/36 (31%)
A : 0/53
B : 3/53
C : 49/53
D : 1/53
15/53(28%)
0.6
0.7
TDM measurements – lateral part of the knee
• LAPFE : Antero-Posterior maximal
Length of the Lateral Femoral
condyle
• LAPTE : Antero-Posterior maximal
Length of the Lateral Tibial
plateau
• VFE : maximal Vertical of the
Lateral Femoral condyle
• VTE : maximal Vertical of the
Lateral Tibial plateau
TDM measurements – medial part of the knee
• LAPFI : Antero-Posterior maximal
Length of the Medial Femoral
condyle
• LAPTI : Antero-Posterior maximal
Length of the Medial Tibial
plateau
• VFI : maximal Vertical of the
Medial Femoral condyle
• VTI : maximal Vertical of the
Medial Tibial plateau
Ratios evaluation
Femoral / Tibial Lenght Ratio
• RLE : Length Lateral Ratio =
LAPFE / LAPTE
• RLI : Length Medial Ratio =
LAPFI / LAPTI
• CFE : Lateral Femoral condyle
Femoral condyle Convexity
Convexity = LAPFE / VFE
• CFI : Medial Femoral condyle
Convexity = LAPFI / VFI
• CTE : Lateral Tibial plateau
Convexity = LAPTE / VTE
• CTI : Medial Tibial plateau
Concavity = LAPTI / VTI
Tibial plateau Convexity/Concavity
RESULTS
• Only ratios analysis +++
• To avoid measurement error from the CT-scan software
• To have comparable datas
• Comparison :
• Groups with and without MM tears
• Male and female groups
RESULTS
FEMALE
(N=39)
MALE
(N=50)
p
RLE : Length Lateral Ratio
2.1
2.1
0.4
RLI : Length Medial Ratio
1.6
1.6
0.4
CFE : Lateral Femoral condyle
Convexity
3.2
3.0
0.1
CFI : Medial Femoral condyle
Convexity
2.9
2.9
0.4
CTE : Lateral Tibial plateau
Convexity
12.4
17.8
0.04
CTI : Medial Tibial plateau
Concavity
15
14.9
0.5
=> Female anatomic characteristics :
• Smaller CTE = Increasing convexity of the lateral tibial plateau
• Same conclusion in study of Wahl et al.
RESULTS
WITH
MM tears (N=36)
WITHOUT
MM tears (N=53)
p
RLE : Length Lateral Ratio
2.14
2.13
0.4
RLI : Length Medial Ratio
1.63
1.56
0.04
CFE : Lateral Femoral condyle
Convexity
3.22
3.04
0.2
CFI : Medial Femoral condyle
Convexity
2.91
2.96
0.2
CTE : Lateral Tibial plateau
Convexity
18.86
14.55
0.2
CTI : Medial Tibial plateau
Concavity
15.74
14.49
0.1
=> Smaller medial tibial plateau length relative to the
medial femoral condyle length
= MM tears risk factor +++ in association
with acl rupture
Increasing contact force pressure on the meniscus in rotation knee movement
MM tears
ISOLATED MM TEARS ANATOMIC RISK FACTORS
• Medial 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.
CONCLUSION
• Preliminary study…
• Correlation with IKDC score, pivot shift, etc....
• Is there also an anatomic risk factor for LM tears ?
Analysis on 900 ct-scan
CONCLUSION
Smaller medial tibial plateau length
relative to the medial femoral condyle length
is a risk factor of MM tears +++
associated with ACL rupture
• Increasing contact force pressure on the MM
• Contact force pressure = risk factor of MM tears +++
Thank you
Thank you