Description
Objectives: Residual rotational laxity after anterior cruciate ligament reconstruction (ACLR) can compromise postoperative outcomes and lead to knee osteoarthritis progression. Since the lateral meniscus (LM) is a secondary stabilizer of the ACL, its dysfunction is one of the causes of residual rotational laxity of the knee joint. In this study, we performed LM suture and centralization during ACLR in patients with ACL+LM injury and investigated the changes in its effect on rotational stability. Methods: Preoperative tibial acceleration was measured in both knees of 19 patients undergoing double-bundle ACLR with semitendinosus tendon for initial ACL injury by performing a pivot-shift test under anesthesia (PreOP group) with a triaxial accelerometer (KiRA). The healthy side was used as the control group. In ACLR patients with suture requiring LM injuries, the graft tension was set to 5 N for the anteromedial bundle (AM bundle), 5 N for the posterolateral bundle (PL bundle) (A5P5), and A10P10 using a graft tensioning system, and tibial acceleration was measured before (LM injured group) and after LM suture (LM suture group) and after additional centralization (LM centralization group) using KiRA. Multiple comparisons of tibial acceleration data were performed in the control group and in each state. 2 2 2 2 Results: In A5P5, tibial acceleration was significantly lower in the LM injured group (5.0±1.6m/s ), the LM suture group (4.0±0.9m/s ), and the LM suture and centralization group (2.9±1.0m/s ) compared to PreOP group (8.2±2.2m/s ). Furthermore, it was significantly lower with LM suture and centralization than with ACLR without LM repair. The same results were observed in A10P10 (LM injured: 4.5±1.5m/s , LM suture: 3.5±1.0m/s , LM suture and centralization: 2.8±0.8m/s ). 2 2 2 Conclusions: Recently, lateral extra-articular tenodesis (LET) and anterolateral structure reconstruction (ALSR) have been performed in patients with ACL injuries who have risk factors for residual rotational laxity of the knee joint after ACLR, but they are relatively higher invasive procedures. On the other hand, the centralization technique requires no sacrifice of the native tissues and is a less invasive and relatively simple procedure compared to these techniques. This study revealed that the centralization technique would be a useful alternative candidate to LET and ALSR.
