Deep medial collateral ligament plays a stabilising role under degenerative medial meniscus root tears.

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-02-20 DOI:10.1002/ksa.12610

Luis Fernando Z Funchal, Leonardo Galibern, Rafael Ortiz, Diego C Astur, Moises Cohen, Carlos R Roesler, Eduardo A Fancello

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引用次数: 0

Abstract

Purpose: Several posterior medial meniscal root (PMMR) repair techniques have been developed to restore the load-bearing function of the meniscus and reduce extrusion. The medial meniscotibial ligament (MMTL) has been shown to play a significant role in meniscal stability. This study evaluates the stabilising function of the MMTL by directly influencing the force exerted on the PMMR during weight-bearing and valgus motion of the knee. Our aim is to investigate whether loss of MMTL integrity is a determining factor in PMMR subluxation.

Methods: Using a 3D model of the knee with parameters from experimental studies, compressive and valgus loading scenarios were simulated using the finite element method to analyse the mechanical response of different knee structures. To investigate the correlation between the integrity of the MMTL and the force acting on the PMMR, different degrees and types of injuries to both structures were modelled for comparison with the healthy joint, providing insights into their importance in preventing or correcting extrusion.

Results: During compressive loading, tears in the MMTL and PMMR result in a 5.8% and 30.9% increase in meniscal extrusion, respectively, while a combined injury results in a 43.9% increase, indicating that the MMTL provides a secondary constraint against extrusion. Moreover, the importance of the MMTL in restraining extrusion becomes more pronounced as the PMMR weakens, as is typical in degenerative tears. Finally, during valgus motion, the MMTL prevents separation of the meniscus from the tibial plateau and reduces strain/stress on the PMMR.

Conclusion: The integrity of the MMTL plays a crucial role in reducing meniscal extrusion and PMMR overload, particularly when the root is affected by degenerative tears. Therefore, surgical repair of the MMTL can improve meniscal function, potentially reducing the risk of osteoarthritis and should be considered as a better treatment strategy for PMMR tears.

Level of evidence: Level III.

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深内侧副韧带在退行性内侧半月板根撕裂中起稳定作用。

目的：几种后内侧半月板根（PMMR）修复技术已经被开发出来，以恢复半月板的承重功能并减少挤压。内侧半月板韧带（MMTL）已被证明在半月板稳定性中起重要作用。本研究通过直接影响负重和膝关节外翻运动时施加在PMMR上的力来评估MMTL的稳定功能。我们的目的是研究MMTL完整性的丧失是否是PMMR半脱位的决定性因素。方法：采用三维膝关节模型，结合实验研究参数，采用有限元法模拟压缩和外翻载荷情况，分析不同膝关节结构的力学响应。为了研究MMTL的完整性与作用在PMMR上的力之间的相关性，对两种结构的不同程度和类型的损伤进行建模，并与健康关节进行比较，从而深入了解它们在预防或纠正挤压方面的重要性。结果：在压缩载荷期间，MMTL和PMMR撕裂分别导致半月板挤压增加5.8%和30.9%，而联合损伤导致半月板挤压增加43.9%，表明MMTL提供了对挤压的二次约束。此外，随着PMMR减弱，MMTL在抑制挤压方面的重要性变得更加明显，这在退行性撕裂中是典型的。最后，在外翻运动期间，MMTL防止半月板从胫骨平台分离，减少对PMMR的应变/应力。结论：MMTL的完整性在减少半月板挤压和PMMR超载方面起着至关重要的作用，特别是当根受到退行性撕裂的影响时。因此，MMTL的手术修复可以改善半月板功能，潜在地降低骨关节炎的风险，应该被认为是PMMR撕裂的更好治疗策略。证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).