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Title: The Effect of Lateral Extra-articular Tenodesis in an ACL-Reconstructed Knee With Partial Medial Meniscectomy: A Biomechanical Study.
Author: Özbek EA, Runer A, Dadoo S, DiNenna M, Linde M, Smolinski P, Musahl V, Mcclincy MP.
Journal: Am J Sports Med; 2023 Nov; 51(13):3473-3479. PubMed ID: 37724758.
Abstract:
BACKGROUND: Knee laxity increases with medial meniscectomy in anterior cruciate ligament (ACL)-reconstructed knees; however, the biomechanical effect of an additional lateral extra-articular tenodesis (LET) is unknown. PURPOSE/HYPOTHESIS: The purpose of this study was to determine the kinematic effect of a LET in knees that underwent combined ACL reconstruction (ACL-R) and partial medial meniscus posterior horn (MMPH) meniscectomy. It was hypothesized that the addition of LET would reduce laxity in the ACL-reconstructed knee. STUDY DESIGN: Controlled laboratory study. METHODS: Ten fresh-frozen human cadaveric knees (mean age, 41.5 years) were tested using a robotic system under 3 loads: (1) 89.0 N of anterior tibial (AT) load, (2) 5 N·m of internal rotation (IR) tibial torque, and (3) a simulated pivot shift-a combined valgus of 7 N·m and IR torque of 5 N·m-at 0°, 15°, 30°, 45°, 60°, and 90° of knee flexion. Kinematic data were acquired in 4 states: (1) intact, (2) ACL-R, (3) ACL-R + partial MMPH meniscectomy (MMPH), and (4) ACL-R + partial MMPH meniscectomy + LET (MMPH+LET). RESULTS: In response to AT loading, there was a significant increase seen in AT translation (ATT) in the MMPH state at all knee flexion angles compared with the ACL-R state, with the highest increase at 90° of knee flexion (mean difference, 3.1 mm) (P < .001). Although there was a significant decrease in ATT at 15° of knee flexion with MMPH+LET (P = .022), no significant differences were found at other knee flexion angles (P > .05). In MMPH with IR torque, a significant increase was observed in IR at all knee flexion angles except 90° compared with the ACL-R state (range, 2.8°-4.9°), and this increase was significantly decreased at all flexion angles with the addition of LET (range, 0.7°-1.6°) (P < .05). CONCLUSION: Performing a partial MMPH meniscectomy increased ATT and IR in response to AT and IR loads compared with the isolated ACL-R state in a cadaveric model. However, when the LET procedure was performed after partial MMPH meniscectomy, a significant decrease was seen at all knee flexion angles except 90° in response to IR and torque, and a significant decrease was seen at 15° of knee flexion in response to AT load. CLINICAL RELEVANCE: LET may be a useful adjunct procedure after ACL-R with partial MMPH meniscectomy to reduce knee laxity.

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