The Effect of Progressive Degrees of Medial Meniscal Loss on Stability after Anterior Cruciate Ligament Reconstruction

Abstract

Previous studies report conflicting results on whether loss of the medial meniscus compromises knee stability after reconstruction of the anterior cruciate ligament (ACL). The purpose of this study was to determine whether the degree of medial meniscus deficiency affects the stability of the ACL-reconstructed knee. Six cadaveric knees were arthroscopically reconstructed with bone-patellar tendon-bone autografts using an anatomic "footprint" technique. Knees tested were ACL-deficient and after reconstruction under three different meniscal states: with partial medial meniscectomy, subtotal meniscectomy, and meniscal root transection. Biomechanical testing was performed at 30 and 60 degrees of flexion under two loading conditions: (1) 134-N anterior tibial load termed anterior tibial translation (ATT) and (2) 10-Nm valgus load combined with 5 Nm of internal tibial torque termed provocative pivot maneuver (PPM). Knee kinematics was measured using a custom activity simulator, motion analysis system, and three-dimensional CT reconstructions. During both ATT and PPM loading, ACL deficiency resulted in a significant increase in anterior translation compared with knees with an intact ACL or those that had undergone ACL reconstruction (p < 0.05). Neither the addition of a partial nor subtotal medial meniscectomy led to increased instability. Only after medial meniscal root transection was increased instability of the ACL-deficient knee detected compared with intact, partial, or subtotal meniscectomy states (p < 0.01). In all states of meniscal deficiency, ACL reconstruction restored internal tibial rotation and anterior translation at 30 degrees to that of the intact knee (p > 0.05). Anatomic single bundle ACL reconstruction was able to restore knee stability in all conditions of medial meniscal deficiency.