1. 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

2. = FREQUENT ASSOCIATION +++
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.

3. No DATA in litterature ANATOMIC RISK FACTORS
MM ACUTE TEARS + ACL ACUTE RUPTURE
CLINICAL RISK FACTORS
Male
Contact injury
Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport, Tandogan et al.
ANATOMIC RISK FACTORS
No DATA in litterature

4. 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 Injury: Sex or Geometry?, Wahl et al.

5. 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

6. 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

7. 2 groups With MM tears Without MM tears 24 males 12 females
N = 89
2 groups
With
MM tears
Without
MM tears
Traumatic / acute
MM tears
24 males
12 females
= 36 patients
26 males
27 females
= 53 patients

8. WITH MM tears (N=36) WITHOUT MM tears (N=53) p
Mean age
35 years
30 years
0.06
Weight (kg) 74 70
0.3
Height (cm)
173
172
0.4
BMI (kg/m2) 25 24
Injury mechanism
Sport : 29/36
Home : 2/36
Work : 4/36
Road accident : 1/36
Sport : 45/53
Home : 3/53
Work : 3/53
Road accident : 2/53
0.5
Mean delay between traumatic event and surgery
3.4 months
0.9
Tegner activity score
6.1
6.2
IKDC score
A : 0/36
B : 3/36
C : 33/36
D : 0/36
A : 0/53
B : 3/53
C : 49/53
D : 1/53
0.6
LM tears association
11/36 (31%)
15/53(28%)
0.7

9. 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

10. 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

11. Ratios evaluation RLE : Length Lateral Ratio = LAPFE / LAPTE
Femoral / Tibial Lenght Ratio
RLE : Length Lateral Ratio = LAPFE / LAPTE
RLI : Length Medial Ratio = LAPFI / LAPTI
CFE : Lateral Femoral condyle Convexity = LAPFE / VFE
CFI : Medial Femoral condyle Convexity = LAPFI / VFI
CTE : Lateral Tibial plateau Convexity = LAPTE / VTE
CTI : Medial Tibial plateau Concavity = LAPTI / VTI
Femoral condyle Convexity
Tibial plateau Convexity/Concavity

12. RESULTS Only ratios analysis +++ Comparison :
To avoid measurement error from the CT-scan software
To have comparable datas
Comparison :
Groups with and without MM tears
Male and female groups

13. RESULTS
FEMALE
(N=39)
MALE
(N=50) p
RLE : Length Lateral Ratio
2.1
0.4
RLI : Length Medial Ratio
1.6
CFE : Lateral Femoral condyle Convexity
3.2
3.0
0.1
CFI : Medial Femoral condyle Convexity
2.9
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.

14. 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
CTE : Lateral Tibial plateau Convexity
18.86
14.55
CTI : Medial Tibial plateau Concavity
15.74
14.49
0.1

15. = MM tears risk factor +++ in association with acl rupture
=> 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

16. = Risk factor of associated MM tears
ACL rupture : rotation instability +++
Increasing potential rotation knee movement
Rotation knee movement : MM tears risk factor
Chronic ACL rupture = MM tears +++
Increasing contact force pressure on meniscus : meniscus tears risk factor
Male and contact sport = MM tears risk factors +++
=> Smaller tibia relative to the femur
= Risk factor of associated MM tears
in acute ACL rupture

17. => Smaller tibial plateau length relative to the femur ?
=> Comparable to other studies about isolated MM tears anatomic risk factors :
2010 : Cam impingement of the posterior femoral condyle in medial meniscal tears, Suganuma et al.
=> Smaller tibial plateau length relative to the femur ?
2012 : The potential effect of anatomic relationship between the femur and the tibia on medial meniscus tears, Bozkurt et al.
=> Medial femoro-tibial incongruence ?

18. 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.

19. 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

20. 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 +++

21. Thank you
Thank you