Alteration of Knee Kinematics After Anatomic Anterior Cruciate Ligament Reconstruction Is Dependent on Associated Meniscal Injury.

BACKGROUND

Limited in vivo kinematic information exists on managing meniscal injury during anterior cruciate ligament reconstruction (ACLR).

HYPOTHESIS: Isolated anatomic ACLR restores knee kinematics, whereas ACLR in the presence of medial meniscal injury is associated with altered long-term knee kinematics.

STUDY

DESIGN

Cohort study; Level of evidence, 3.

METHODS

From March 2011 to December 2012, 49 of 57 participants in a clinical trial underwent anatomic ACLR with successful kinematic testing at 24 months after ACLR. Twenty-five patients had associated meniscal tears: medial (n = 11), lateral (n = 9), or bilateral (n = 5). With a dynamic stereo radiography system with superimposed high-resolution computed tomography scans of patient knees, kinematics were measured during downhill running. The initial single-support phase of the gait cycle (0%-10%) was analyzed.

RESULTS

Anterior tibial translation (ATT) was the only kinematic outcome between patients' ACLR and contralateral knees that had significant interactions among meniscal groups ( P = .007). There was significant difference in ATT between patients with intact menisci and medial tears ( P = .036) and with medial tears and lateral tears ( P = .025). Patients with intact menisci had no difference in ATT, with a negligible effect size between the ACLR and contralateral knees (mean ± SEM: 13.1 ± 0.7 mm vs 12.6 ± 0.5 mm, P = .24, Cohen d = 0.15, n = 24), while patients with medial meniscal tears had an increase in ATT, with a medium effect size between the ACLR and contralateral knees (15.4 ± 1.0 mm vs 13.2 ± 1.0 mm, P = .024, Cohen d = 0.66, n = 11).

CONCLUSION

Associated medial meniscal injury in the setting of ACLR leads to increased ATT at 24-month follow-up. Furthermore, isolated anatomic ACLR in the absence of meniscal injury demonstrated no significant difference from native knee kinematics at 24-month follow-up during rigorous "high demand" knee activity with the current sample size. Patients undergoing anatomic ACLR in the presence of medial meniscal injury remained at a higher likelihood of sustaining altered long-term knee kinematics.