Meniscotibial Ligament Insufficiency Increases Force on the Posterior Medial Meniscus Root

Abstract

Background: Posterior medial meniscus root (PMMR) tears are a challenge to assess and treat. However, the forces sustained at the PMMR are yet to be fully characterized. In addition, it has been shown that meniscotibial ligament (MTL) injuries happen before PMMR tears, suggesting that insufficiency of the MTL results in a change of forces acting on the PMMR. Purpose/Hypothesis: The purpose of this study was to evaluate the 3-dimensional forces acting on the PMMR in the intact, MTL cut, and MTL tenodesis states. It was hypothesized that the MTL cut state would increase medial shear forces seen at the PMMR, whereas the medial shear force in the MTL tenodesis state would return PMMR forces to that of the intact state. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen cadaveric knees were tested in 3 states (intact, MTL cut, and tenodesis). A 3-axis load cell was installed below the posterior tibial plateau and attached to the enthesis of the PMMR. The specimen was mounted to a load frame that applied an axial load, an internal torque, and an external torque. The amount of compression-tension, mediolateral shear force, and anteroposterior shear force acting on the PMMR was measured. Results: When the joint was loaded in compression, the MTL cut state significantly increased compression of the PMMR (P = .0368). The tenodesis state did not significantly restore forces of the PMMR (P = .008). When the joint was loaded in external torque, the MTL cut state significantly increased compression (P < .0001) and significantly decreased anterior shear on the PMMR (P = .0003). The tenodesis state did not significantly restore forces on the PMMR to the intact state (P < .0001). Increased flexion angle significantly increased medial shear forces of the PMMR when the joint was loaded in compression (P < .007 at every angle). Conclusion: When evaluated biomechanically, MTL insufficiency resulted in increased compressive force at the PMMR. A single-anchor centralization procedure did not restore PMMR forces to that of the intact state. Increased knee flexion angle resulted in increased medial shear force on the PMMR. Clinical Relevance: The findings in this study provide clinicians information on PMMR forces when the MTL is disrupted. These data can aid in the decision-making for adding an MTL repair to augment PMMR repairs.