Repair of Lateral Meniscus Posterior Horn Detachment Lesions

Abstract

Background: Posterior horn detachment (PHD) lesions of the lateral meniscus are commonly associated with acute anterior cruciate ligament (ACL) tears. Multiple surgeons have advocated for repair of this lesion at the time of ACL reconstruction. However, the biomechanical consequences of this lesion and its subsequent repair have not been evaluated. Hypothesis: The PHD lesion of the lateral meniscus will lead to increased tibiofemoral contact pressures, and repair of this lesion to bone via a tibial tunnel can restore normal contact pressures during simulated gait. Study Design: Controlled laboratory study. Methods: Lateral compartment contact pressures were measured via a sensor on the tibial plateau in 8 cadaver knees with the knee intact, after sectioning the posterior horn of the lateral meniscus to simulate PHD, and after repairing the injury. The repair was performed using an ACL tunnel guide to drill a tunnel from the anteromedial tibia to the posterior horn attachment site. Dynamic pressure data were continuously collected using a conductive ink pressure sensing system while each knee was moved through a physiological gait flexion cycle. Results: Posterior horn detachment caused a significant increase in tibiofemoral peak contact pressure from 2.8 MPa to 4.2 MPa (P = .03). After repair of the lesion to bone was performed through a transtibial tunnel, the peak contact pressure was 2.9 MPa. Posterior horn detachment also significantly decreased the maximum contact area over which tibiofemoral pressure is distributed from 451 mm2 in the intact state to 304 mm2 in the detached state. Repair of the PHD lesion increased the maximum contact area to 386 mm2, however, this area was also significantly less than in the intact state (P = .05). Conclusion: Posterior horn detachment of the lateral meniscus causes increased peak tibiofemoral contact pressure. The peak pressure can be reduced to a normal level with repair of the lesion to bone via a transtibial tunnel. Clinical Relevance: Posterior horn detachment of the lateral meniscus is a lesion often associated with an acute ACL tear. Debate exists concerning the importance of repairing PHD lesions at the time of ACL reconstruction. The data provided in this study may influence surgeons’ management of the lesion.