Horn Of Medial Meniscus Research Articles

Triple Anterior Horn Insertion of the Medial Meniscus Combined with Posterior Horn Hypertrophy: A Rare Case and Brief Literature Review

Anomalies of the medial meniscus (MM) are uncommon. The most frequently occurring anomaly is found in the anterior horn. This report describes for the first time a case of abnormal multiple insertions of the anterior horn of the MM (AHMM) combined with posterior horn hypertrophy, which was found incidentally during routine dissection of a separate left lower limb from an adult cadaver. The AHMM was found to have a standard attachment to the anterior surface of the tibia in addition to two additional bands. One of these bands was the anteromedial meniscofemoral ligament, which ran parallel and independent of the anterior cruciate ligament and ended at the intercondylar notch of the femur. The other band extended as the transverse ligament that connected the AHMM to the lateral meniscus. The posterior horn of MM was found to be hypertrophied. The clinical implications of these anomalies are discussed below along with a relevant literature review.

Poster 256: Pediatric Meniscus Repair: Safety Profile based on > 2000 Arthroscopic Meniscus Repairs

Objectives: Pediatric meniscus tear prevalence is increasing, and meniscus preservation methods are essential for long term knee function in this at risk group. In this patient population meniscus anatomy and vascularity may support higher rates of healing after repair, but safety of meniscus repair has not been studied in a large prospective cohort group. The purpose of this study is to establish the incidence of complications associated with pediatric meniscus repairs in a multi-center prospective quality improvement registry, and to identify the characteristics of meniscus repair that are associated with complications. Methods: A prospective multi-center quality improvement registry (16 institutions, 26 surgeons) monitoring the safety of meniscus repairs was reviewed. Audit processes using CPT codes were designed to ensure that all consecutive cases were prospectively entered on patients <19 years old into a HIPAA- compliant electronic platform. Each meniscus repair case with a complication form was secondarily reviewed to ensure consistency of identification and grading according to the modified Clavien Dindo classification. Demographics, tear type, repair technique, and implant type, when applicable, were included, and a common cause analysis was performed to evaluate risk factors for early repair failures. Results: 2375 meniscus repair cases were identified, with a mean age of 15.1 years (2-19) and 44.1% females. These consisted of (25%) isolated repair, (5.4%) discoid meniscus repair, and (66.9%) concomitant ACL and meniscus repair. Overall complication rate was 12.64%, with 5.67% grade III complications. The most common complications were motion loss/stiffness (3.96%), failed repair (2.3%) and continued pain/mechanical symptoms (2.09%). Failed repair was identified in all repair groups but had the highest prevalence in isolated meniscus repair (6.38%), in which grade III complications were more common overall. Stiffness was more common when a meniscus repair was performed during an ACL reconstruction (2.1% Grade II and 1.27% Grade III). There was no statistical difference in complications associated with age, gender, or technique, medial or lateral meniscus, displacement, or zone of repair. However, posterior horn and posterior horn + body repairs of the medial meniscus sustained more complications (p=0.003) as did longitudinal/complex tears of the lateral meniscus (p=0.02). Conclusions: Pediatric meniscus repairs performed arthroscopically have a complication rate of 12.64%, with 1 and 20 meniscus repairs leading to a grade III complication. Although there is no difference in complications based on technique, posterior horn medial meniscus and longitudinal tears of lateral meniscus may be at higher risk of complications.

MR evaluation of the posteromedial corner of the knee: association of posterior horn medial meniscus tear with posterior oblique ligament and distal semi-membranosus tendon tear.

To assess if posterior oblique ligament and distal semi-membranosus tendon tears are associated with posterior horn medial meniscus tears on MRI. From January 1, 2018 to December 31, 2019, 56 patients who met the inclusion criteria were enrolled in this study. Of the 56 patients, 43 patients who had a posterior horn of medial meniscus tear were included in the study group. A control group of 13 individuals was formed for comparison. Two radiologists reviewed the MR images and recorded the presence and grades of posterior oblique ligament and distal semi-membranosus tendon tears. We used the independent t-test and one-way ANOVA to compare the tear grades. Interobserver agreement was analyzed using a Cohen's κ coefficient (κ value) for categorical variables. The mean grades for the posterior oblique ligament and distal semi-membranosus tendon tears were significantly higher in the study group (all, p < 0.001). Interobserver agreement between the two readers was substantial in assessing the grade of posterior oblique ligament tear (κ = 0.653±0.087) and almost perfect in assessing the grade of distal semi-membranosus tendon tear (κ = 0.876±0.060). Posterior oblique ligament and distal semi-membranosus tendon tears are significantly associated with posterior horn of medial meniscus tear and medial meniscus posterior root tears, and the peel-back mechanism could be related to this association. Presenting this paper could adjust radiologist search patterns and potentially help orthopedists with management and pre-surgical planning for the posteromedial corner injury of the knee.

The Wave Sign Correlates with the Posterior Horn Medial Meniscus (PHMM) Tear in the Anterior Cruciate Ligament (ACL) Deficient Knee.

A posterior horn medial meniscus (PHMM) tear subjects the knee to pathological stresses, especially in the setting of a deficient anterior cruciate ligament (ACL). These PHMM tears have to be surgically addressed, however they remain a diagnostic challenge. Hence, this study aims to evaluate the wave sign as an arthroscopic diagnostic aid for the PHMM tear which may be occult. This is a retrospective study of 61 consecutive patients (62 ACL-deficient knees) who underwent arthroscopic primary ACL reconstruction between September 2017 and August 2018. We defined PHMM tears as tears located in the posterior one-third of the medial meniscus. Root tears and ramp lesions were included in our analysis. The arthroscopic findings were recorded after a comprehensive arthroscopic survey. In the sample of ACL-deficient knees, 44 (71.0%) had a concomitant medial meniscus tear. The most common location for the tear was in the posterior horn (81.8%). There were seven occult PHMM tears, not described by the radiologist or identified by the operating surgeon on the pre-operative magnetic resonance imaging. The wave sign was identified in 10 (16.1%) knees, all confirming the presence of the PHMM tear. A positive correlation was found between the presence of the wave sign and the PHMM tear. The wave sign has a statistically significant but weak positive correlation with the presence of the PHMM. We view the wave sign as a valuable arthroscopic cue to rule-in the presence of the PHMM tear in the ACL-deficient knee.

Histologically Confirmed Recellularization is a Key Factor that Affects Meniscal Healing in Immature and Mature Meniscal Tears.

Healing outcomes of meniscal repair are better in younger than in older. However, exact mechanisms underlying superior healing potential in younger remain unclear from a histological perspective. This study included 24 immature rabbits and 24 mature rabbits. Tears were created in the anterior horn of medial meniscus of right knee in each rabbit. Animals were sacrificed at 1, 3, 6, and 12 weeks postoperatively. We performed macroscopic and histological evaluations of post-meniscal repair specimens. Cells were counted within a region of interest to confirm cellularization at tear site in immature menisci. The width of cell death zone was measured to determine the region of cell death in mature menisci. Apoptosis was evaluated by TUNEL assay. Vascularization was assessed by CD31 immunofluorescence. The glycosaminoglycans and the types 1 and 2 collagen content was evaluated by calculating average optical density of corresponding histological specimens. Cartilage degeneration was also evaluated. Healing outcomes following untreated meniscal tears were superior in immature group. Recellularization with meniscus-like cell morphology was observed at tear edge in immature menisci. Superior recellularization was observed at meniscal sites close to joint capsule than at sites distant from the capsule. Recellularization did not occur at tear site in mature group; however, we observed gradual enlargement of cell death zone. Apoptosis was presented at 1, 3, 6, 12 weeks in immature and mature menisci after untreated meniscal tears. Vascularization was investigated along the tear edges in immature menisci. Glycosaminoglycans and type 2 collagen deposition were negatively affected in immature menisci. We observed glycosaminoglycan degradation in mature menisci and cartilage degeneration, specifically in immature cartilage of the femoral condyle. In conclusion, compared with mature rabbits, immature rabbits showed more robust healing response after untreated meniscal tears. Vascularization contributed to the recellularization after meniscal tears in immature menisci. Meniscal injury fundamentally alters extracellular matrix deposition.

Functional outcome of medial meniscus root repair in medial compartment osteoarthritic knee and it’s correlation with preexisting comorbidities

Objective: The knee joint is one of the most commonly affected joints of the body and this can be attributed to its exposure to external forces and the high functional demands placed on the joint. Meniscal root tears have conventionally been treated with menisectomy and in this study we evaluate the effects of repairing the torn posterior medial meniscal root. We also study the effects of age and body mass index on the postoperative outcome of the patient. Methods: 35 patients with posterior horn medial meniscus root tear were operated with root repair with either a fibre wire/ fibre tape or their pre and post-operative tegner lysholm scores were evaluated. Results and Conclusions: The evaluation was suggestive that medial meniscus root repair improved outcomes. Additionally, a relationship was established between the body mass index and patient age with that of the post-operative function.

Macromolecular fraction (MMF) from 3D ultrashort echo time cones magnetization transfer (3D UTE-Cones-MT) imaging predicts meniscal degeneration and knee osteoarthritis

Meniscal degeneration is strongly associated with osteoarthritis (OA). We aimed to evaluate a 3D ultrashort-echo-time Cones magnetization transfer (UTE-Cones-MT) sequence for quantification of macromolecular fraction (MMF) and MT ratio (MTR) in menisci of healthy volunteers and patients with different degrees of OA. Patients with mild OA (n=19; 37-86 years; 10 males) or advanced OA (n=12; 52-88 years; 4 males) and healthy volunteers (n=17; 20-49 years; 7 males) were scanned with T2-FSE and UTE-Cones-MT sequences at 3T. Morphological assessment was performed using meniscal whole-organ magnetic resonance imaging score (WORMS). MMF and MTR were calculated for menisci, and correlated with age and meniscal WORMS scores. The diagnostic efficiency was performed by using receiver operating characteristic (ROC) curve and the area under the curve (AUC) analyses. Decreased MMF and MTR were observed in menisci of patients with mild or advanced OA compared with healthy subjects, and in menisci with tears (Grade 2-4) compared with normal menisci (Grade 0). Significant negative correlations were observed between MMF (r=-0.769, P<0.01), MTR (r=-0.320, P<0.01), and meniscal WORMS score. There was a mild negative correlation between MMF (r=-0.438, P<0.01), MTR (r=-0.289, P<0.01), and age. The AUC values of MMF and MTR in the four horns of meniscus and the posterior horn medial meniscus for differentiating OA patients from healthy volunteers were 0.762 and 0.699, and 0.835 and 0.883, respectively. The 3D UTE-Cones-MT biomarkers of MTR and especially MMF can detect compositional changes in meniscus and differentiate healthy subjects from patients with mild or advanced knee OA.

Biomechanical Comparison of an All-Inside Meniscal Repair Device Construct Versus Pullout Sutures for Arthroscopic Transtibial Repair of Posterior Medial Meniscus Root Tears: A Matched-Pair Cadaveric Study.

Background:Meniscus root repairs are important for restoring knee function after a complete meniscus root tear. Various suturing patterns have been proposed for the root repair. The 2-simple-stitches (TSS) method is currently the preferred technique, as it is simplest to perform and allows the least displacement of the meniscus root.Purpose:To compare the biomechanical properties of a posterior medial meniscus transtibial root repair consisting of an all-inside meniscal repair device (AMRD) construct with the TSS pullout suture pattern.Study Design:Controlled laboratory study.Methods:Ten pairs of cadaveric medial menisci were prepared with 1 of the 2 constructs. The constructs were randomized between pairs. All constructs were subjected to preloading with 2 N for 10 seconds and then cyclic loading from 5 N to 20 N for 1000 cycles at a frequency of 0.5 Hz. Subsequently, the menisci were loaded to failure at a rate of 0.5 mm/s. All loads were applied in-line with the circumferential meniscal fibers near the posterior medial meniscal horn.Results:The mean yield load and stiffness were similar for both constructs. The elongation after cyclic loading was greater for the AMRD. The displacement at both yield load and ultimate failure were also higher for the AMRD. The ultimate failure load of the AMRD was also significantly higher. During load to failure, the mode of failure in the AMRD was heterogeneous. All the TSS constructs failed by suture cutout.Conclusion:Posterior medial meniscus root repairs using both the AMRD and TSS constructs have elongation under the biomechanically acceptable threshold of 3 mm. The stiffness and yield loads indicate similar mechanical properties of the constructs. However, the significantly higher elongation for the AMRD leaves the TSS method as the preferred option for transtibial repairs. Despite this, the AMRD construct may still represent a viable alternative to the TSS suture pattern, comparable to alternative suture patterns with similar limitations.Clinical Relevance:The AMRD construct may represent a viable alternative to the TSS suture pattern.

Arthroscopic Medial Meniscal Posterior Root Repair With Transtibial Luggage-Tag and Horizontal Mattress Sutures

Medial meniscal posterior root repair techniques have shown positive yet varied results in the literature. The decision to perform repair has improved clinical outcomes in many situations, although the healing rate is approximately 64% and the repair strength is roughly one-third of the native root strength, with meniscal extrusion being common. We present a technique based on biomechanical evidence to obtain a strong anatomic posterior root repair to restore nearly normal knee mechanics, combining an increased size of footprint under the lateral aspect of the medial meniscal horn for healing and a luggage-tag suture with a posteriorly placed horizontal mattress suture. The horizontal mattress suture is passed to capture the circumferential fibers of the meniscus and the luggage-tag suture is passed to capture the radial fibers of the meniscal body, through a single transtibial tunnel. The aim of this repair is to restore the normal meniscal function.

A comparative study of magnetic resonance imaging and arthroscopy in internal derangement of knee

The purpose of this study is to compare the findings of magnetic resonance imaging with arthroscopy in internal derangements of knee and to assess the sensitivity, specificity and accuracy of magnetic resonance imaging in comparison to arthroscopy. Methods and Materials: Fifty six patients with history of suspected internal derangement of knee were evaluated prospectively with MRI and compared with arthroscopy during a one and half a year period from January 2016 to June 2017 at Katuri Medical College & Hospitals, Chinakondrupadu, Guntur. 1.5 Tesla MRI machine using a closed extremity coil is used. Commonly used sequences in MRI of the knee include Turbo-spin echo (TSE), FFE (Gradient echo) and Short Tau Inversion Recovery (STIR) sequences in Axial, Sagittal and Coronal planes using a slice thickness of 3 mm with a 0.3 mm slice gap. Arthroscopy of the knee with standard anteromedial and anterolateral portals with the patient in supine position done in all the cases. Observations: The diagnostic sensitivity, specificity and accuracy of MRI in detecting cruciate ligament and meniscal injuries as compared to arthroscopy is as follows: Anterior Cruciate Ligament (ACL): 97.29%, 89.47%, 94.64% ; Posterior Cruciate Ligament (PCL): 100%, 100%, 100%; Medial Meniscus (MM): 100%, 93.33%, 98.21% and Lateral Meniscus (LM): 93.10, 92.59, 92.85. Most common lesions found were ACL and Medial Meniscal tears (posterior horn of MM being the most common site). Summary and Conclusion: MRI is a useful non-invasive modality having high sensitivity, specificity and accuracy in diagnosing cruciate ligament and meniscal injuries. MRI should be considered as the first line of investigation in all patients with suspected internal derangements of knee. MRI being easily available and non-invasive is useful as a pre-operative screening modality, thus improves the quality of diagnostic and therapeutic arthroscopies and further reduces the morbidity. Arthroscopy is the gold standard in diagnosing c

Quantitative Evaluation of Meniscal Healing Process of Degenerative Meniscus Lesions Treated with Hyaluronic Acid: A Clinical and MRI Study.

Purpose: We aimed to evaluate clinical efficacy and healing effects of conservative management of degenerative meniscus lesions (DMLs) with a hyaluronic acid (HA) hydrogel. Methods: Patients were subjected to two HA injections two weeks apart. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Patient’s Global Assessment (PtGA) and Clinical Observer Global Assessment (CoGA) of the disease were assessed at baseline, 30, and 60 days after treatment. Short Form (36) Health Survey (SF-36) was assessed at baseline and 60 days after treatment. One year after treatment, patients were called to know whether any of them had undergone arthroscopic partial meniscectomy (APM). All patients underwent magnetic resonance imaging using a 1.5-T Magnetic Resonance Imaging (MRI) scanner (Siemens Aera), which included a T2 mapping pulse sequence with multiple echoes at baseline and 60 days after treatment. Results: 40 patients were enrolled. WOMAC score, physical function subscale, PtGA and CoGA, and SF-36 showed a statistically significant difference between baseline and follow-up. One year after treatment, only one patient had undergone APM. A decrease in the T2 measurement was detected in the posterior horn medial meniscus in 39% of cases in both the red and red–white zone, and in 60% of cases in the white zone; in the posterior horn lateral meniscus in 55% of cases in both the red and white zones, and in 65% of cases in the red–white zone. Only for the latter, there was a statistically significant difference between baseline and posttreatment T2 measurements. Conclusion: This study supports the use of HA in the conservative management of DML as it is clinically effective and enhances meniscus healing as demonstrated by T2 measurements. Moreover, it reduces the need for APM at 1-year follow-up.

Uncovered Medial Meniscus Sign on Knee MRI: Evidence of Lost Brake Stop Mechanism of the Posterior Horn Medial Meniscus.

The objective of our study was to evaluate the association between anterior tibial translation and injuries on the posterior horn medial meniscus (PHMM) and the integrity of the brake stop mechanism of the PHMM in the anterior cruciate ligament (ACL)-deficient knee. This retrospective study included 85 consecutive patients with an arthroscopically confirmed complete ACL tear. Anterior tibial translation was quantitatively measured using sagittal MRI at the midpoint of the lateral femoral condyle. The "uncovered medial meniscus" sign was considered positive if a vertical line tangent to the posteriormost margin of the medial tibial plateau intersected the PHMM at the midpoint of the medial femoral condyle on sagittal MRI. Concomitant injuries on the structures of the posteromedial and posterolateral corners of the knee, including PHMM tear and meniscal ramp lesion, were recorded. Stratified subgroup analysis and multivariable regression analysis were performed to identify factors associated with anterior tibial translation. The uncovered medial meniscus sign was positive in 21.2% (18/85) of patients and was significantly associated with anterior tibial translation. In the stratified subgroup analysis and multivariable regression analysis, positive uncovered medial meniscus sign consistently showed a significant association with anterior tibial translation and generated an additional 2.8 mm of anterior tibial translation. Other injuries, including PHMM tear and meniscal ramp lesion, were not associated with anterior tibial translation. The uncovered medial meniscus sign showed a statistically significant correlation with anterior tibial translation and could be a useful marker for the lost brake stop mechanism of PHMM in the ACL-deficient knee.

An Ayurvedic approch to Knee Ligament Injury - A case study

Knee joint is heavily stressed joint in the body. It has two completely incompatible properties of stability and mobility. It heavily depends on quadriceps femoris and collateral ligaments for stability. Due to increasing number of accidents and sports injuries, knee ligament injuries are also increasing in number, which more commonly occurs in anterior cruciate ligament (ACL), medial collateral ligament (MCL) and meniscus. However, surgical reconstruction does not guarantee a previous level of activity. In this single case study an effort is made to manage knee ligament injury through Ayurveda. A 38 years old female suffering from anterior cruciate ligament tear and complex tear in body and posterior horn of medial meniscus was treated with Janu basti and internal medicine. The duration of the treatment was 30 days, which provided relief from pain with noticeable improvement in the movement of knee joint.

Intra-articular pathology associated with isolated posterior cruciate ligament injury on MRI.

Unlike with anterior cruciate ligament injury, little is known about the prevalence of intra-articular pathology associated with isolated posterior cruciate ligament (PCL) injury in the knee. The objectives of this study were to characterize and identify the frequency of meniscal tears and osteochondral injuries in these patients, and to see if management might be affected. Altogether, 48 knee MRI exams with isolated PCL tears were evaluated for the presence of: grade and location of PCL tear, meniscal tear, articular chondral lesion, bone bruise, and fracture. Comparisons between PCL tear grade and location, as well as mechanism of injury when known, with the presence of various intra-articular pathologies, were made using the chi-square or Fisher's exact test as appropriate. In all, 69% of isolated PCL tears occur in the midsubstance, 27% proximally. Meniscal tears were seen in 25% of knees, involving all segments of both menisci, except for the anterior horn medial meniscus. Altogether, 23% had focal cartilage lesions, usually affecting the central third medial femoral condyle and medial trochlea, while 12.5% of knees had fractures, and 48% demonstrated bone bruises, usually involving the central to anterior tibiofemoral joint. The presence of a fracture (p = 0.0123) and proximal location of PCL tear (p = 0.0016) were both associated with the hyperextension mechanism of injury. There were no statistically significant associations between PCL tear grade and presence of intra-articular abnormality. Potentially treatable meniscal tears and osteochondral injuries are relatively prevalent, and demonstrable on MRI in patients with isolated acute PCL injury of the knee.

Knee Injury – Recreational Runner

HISTORY: Case of a 41 year-old army soldier who had an acute bilateral knee giveaway weakness while jogging. After running for a mile, his left knee gaveway and he fell to the floor. He stood up without difficulties and ambulated for a short distance when he fell again due to right knee weakness. He had difficulty ambulating, although he felt no pain. During his ER visit, he had a third fall resulting in a right lateral malleolus fracture. Orthopedics was consulted and performed bilateral patellar tendon repair and right lateral malleolus ORIF. He was discharged home with bilateral hinged knee braces locked at full extension and weight-bearing precautions. Two months post-op, he was admitted to the acute inpatient rehabilitation ward of the VA Caribbean Healthcare. No past medical history of systemic conditions or regular medications. PHYSICAL EXAMINATION: Examination revealed bilateral knee valgus deformity, mild soft tissue swelling and bilateral pes planus. He had full knee extension and limited knee flexion to 90 degrees. Knee special tests were negative for meniscal, cruciate ligament or collateral ligament injury. Neurovascular exam was unremarkable. DIFFERENTIAL DIAGNOSIS: 1. Patellar tendon rupture 2. Quadriceps tendon rupture 3. Anterior cruciate ligament sprain 4. Meniscal injury 5. Collateral ligament sprain TEST AND RESULTS: 1. Bilateral knee MRI: Bilateral full-thickness tear of proximal patellar tendon with cephalad patellar displacement, medial and lateral patellar retinacula tears, and extensive soft tissue edema. Right high-grade partial versus full-thickness anterior cruciate ligament tear and anterior horn lateral meniscus tear. Left posterior horn medial meniscus tear. 2. Bilateral Knee X-ray: Bilateral patella alta. 3. Labs: Essentially normal except for low vitamin D and positive qualitative ANA test. FINAL/WORKING DIAGNOSIS: Atraumatic bilateral patellar tendon rupture TREATMENT AND OUTCOMES: 1. Outpatient-based physical therapy was provided with emphasis on ROM completion, progression of quadriceps strengthening and neuromuscular retraining. 2. He achieved full ROM in both knees and independence in ADL’s and ambulation. 3. Return to recreational sports recommendations included to avoid high impact activities, such as running, until 9-12 months post-op follow up.

Meniscus delivery: a maneuver for easy arthroscopic access to the posterior horn of the medial meniscus.

Pathology of posterior horn of medial meniscus is common and often presents a difficult approach during arthroscopy for various reasons. We describe an easy maneuver to facilitate “delivery of the medial meniscus” during arthroscopy.

The effect of medial meniscal horn injury on knee stability.

This study investigated the effect of damage of the posterior and anterior horns of the medial meniscus on knee stability. Twenty fresh-frozen porcine knees were divided into two groups (anterior horn and posterior horn injury). Each group was tested in three states: intact medial meniscus, posterior or anterior horn of medial meniscus resection and total medial meniscectomy. A robotic testing system was used to test anterior tibial translation (ATT) at 30° (full extension), 60° and 90° of knee flexion with an external anterior tibial load of 89 N, internal rotation (IR) and external rotation (ER) at 30° and 60° of knee flexion under a 4 N m tibial rotation torque. In response to an IR torque, there was a significant difference between the state of intact medial meniscus and anterior and posterior horn damage, except for anterior horn resection at 60° of knee flexion. In response to an ER torque, there were no significant differences between the state of intact meniscus and horn damage except for anterior horn resection at 30° of knee flexion. Meniscal damage had no significant effect on ATT. The results indicated that the posterior horn was more important in controlling the IR stability than the anterior horn with knee flexion, and the anterior horn was more important in controlling the ER stability than the posterior horn at full knee extension in the anterior cruciate ligament-intact knee. These findings further the understanding of the mechanisms, the prevention of injuries and rehabilitation of meniscal horn injury in clinical practice.

Interconnections between the cruciate ligaments and the menisci in the knee (914.3)

The menisci are of great importance for the stabilization and for the pulling and rolling movements of the knee. The aim of this study was to describe the interconnecting fibers between the menisci and the cruciate ligaments and to show their variability.40 tibial plateaus were included from specimen of the anatomical institute.Lateral meniscus: It had in 93,55% connecting fibers to the footprint of the anterior cruciate ligament (ACL). 90,32 % of the lateral menisci had an osseous fixation between the ACL and the posterior cruciate ligament (PCL). Also in the posterior part there is in 51,61% a connection between the posterior horn of the lateral meniscus an the footprint of the ACL. Connections to the PCL were found in 83,87%.Medial meniscus: The anterior horn medial meniscus had in 35,38% an overlapping area with the footprint of the ACL. In 35,48% there was either a partial or complete connection to the ACL. 87,10% of the posterior horns of the medial menisci had an insertion individual to the attachments of the ACL or the PCL. In 12,90% there were connecting fibers either towards the ACL or the PCL.The findings of this study show the complexity of the attachments of the medial and lateral meniscus. These results should have an impact on planning the reconstruction of the menisci and their actual surgery as this states a much more intimate relationship to the cruciate ligaments of the knee than described in literature until now.

Medial meniscus posterior horn zones show differing responses to static loading in subjects with knee osteoarthritis compared to controls

Medial meniscus posterior horn zones show differing responses to static loading in subjects with knee osteoarthritis compared to controls

Patterns of Meniscal Damage Associated with Acute ACL Rupture

Patterns of Meniscal Damage Associated with Acute ACL Rupture