Background: Meniscal extrusion often persists after a medial meniscus root repair. If the meniscus is extruded, the function of the meniscus as a load-sharing device and secondary knee stabilizer is compromised.
Hypothesis: It was hypothesized that repairing the meniscotibial ligament (MTL) would decrease meniscal extrusion in the settings of both an isolated MTL tear and a repaired medial meniscus root while also improving medial compartment contact mechanics.
Study design: Controlled laboratory study.
Methods: Ten fresh-frozen cadaveric knees (mean age, 50.5 years) were tested in 5 conditions: intact, MTL deficiency, MTL deficiency + posterior medial meniscus root deficiency, MTL deficiency + posterior medial meniscus root repair, and MTL tenodesis + posterior medial meniscus root repair. Specimens were mounted to a load frame that applied a 1000-N axial load. Joint contact pressures were measured using thin pressure sensors, and the peak and mean pressures were analyzed. Ultrasound was used to measure meniscal extrusion.
Results: The MTL tear in isolation resulted in significant meniscal extrusion compared with the intact state (P = 0.035) without a detectable difference in medial compartment pressures. The addition of a root tear to the MTL tear state resulted in significantly more extrusion (P = 0.001) and significant increases in medial compartment pressure (P = .030) compared to the MTL tear state. Root repair alone restored extrusion, mean contact pressure, and peak contact pressure back to the intact state (P > .05).
Conclusion: This study showed that MTL disruption led to increased meniscal extrusion in a cadaveric model. Unlike the root tear state, MTL disruption did not change contact mechanics. Furthermore, root repair alone was sufficient in restoring intact biomechanics and extrusion.
Clinical relevance: This study may help clinicians understand the origin of medial meniscus root tears and aid in the decision-making process for whether to add an MTL tenodesis in the setting of root repair.
Keywords: meniscal biomechanics; meniscal extrusion; meniscotibial ligament; ultrasound.