Incidence of Posteromedial Meniscocapsular Separation and the Biomechanical Implications on the Anterior Cruciate Ligament.

PURPOSE: To report the incidence of posterior medial meniscocapsular junction (PMCJ) separation in patients with anterior cruciate ligament (ACL) injury and to evaluate its biomechanical effect on the ACL. METHODS: Three hundred thirty-seven consecutive patients undergoing isolated primary ACL reconstruction were retrospectively analyzed for PMCJ lesion. Forty-four patients were identified with PMCJ lesion and studied. Eight cadaver knees underwent biomechanical testing to determine anterior tibial displacement and anteromedial bundle ACL strain in the intact, PMCJ lesion, and PMCJ repair states at 0°, 30°, 60°, and 90° of flexion. Mixed-effects linear regression with Bonferroni correction was used for statistical analysis. RESULTS: PMCJ tear incidence with ACL disruption was 13.1%. Specimen with PMCJ tears had statistically increased anterior tibial translation at 30° (1.2 mm; P < 0.01) and statistically increased ACL strain at 30° (24%; P < 0.01) and 90° (50%; P < 0.01). With PMCJ repair, translation reduced (P > 0.05) by 12%, 18%, and 10% at 0°, 30°, and 90° of flexion, respectively. PMCJ repair reduced (P < 0.05) ACL strain by 40%, 39%, 43%, and 31% at 0°, 30°, 60°, and 90° of flexion, respectively. CONCLUSIONS: A PMCJ lesion was observed in 13% of ACL injuries. This injury contributes to increased ACL strain, and PMCJ repair markedly reduces ACL strain to preinjury levels.

Anatomic Repair of Posteromedial Meniscocapsular Separation Using an All-Inside Technique.

Separation of the posteromedial meniscocapsular junction (PMC) is a unique injury seen in patients with disruption of the anterior cruciate ligament. PMC tears may go unrecognized despite preoperative magnetic resonance imaging and diagnostic arthroscopy of the medial compartment. Unrepaired lesions may lead to persistent laxity of the knee after anterior cruciate ligament reconstruction. Inside-out repair techniques risk iatrogenic injury to the articular cartilage during needle passage and require dissection of the posteromedial knee for suture retrieval. Previous all-inside techniques have required specialized implants and repaired PMC lesions with direct visualization of the tear. The presented all-inside technique is an easily reproducible, cost-effective means to anatomically repair separation of the PMC. The technique provides the surgeon direct visualization and full arthroscopic access to the lesion, making repair technically easy and efficient.

Comparison of Time to Recurrence of Instability After Open and Arthroscopic Bankart Repair Techniques.

BACKGROUND: The results of open and arthroscopic instability repairs have been shown to be equivalent in recent literature. PURPOSE: To compare the time to recurrence (TTR) of instability and disease-specific outcome measures in patients undergoing open and arthroscopic Bankart repair. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients with recurrent traumatic anterior shoulder instability and a Bankart lesion on diagnostic arthroscopy underwent either open Bankart repair (OB) or arthroscopic Bankart and suture capsulorrhaphy (ABSC) using suture anchors. There was a minimum follow-up of 24 months. The primary outcome measures included Western Ontario Shoulder Instability Index (WOSI) score and time to recurrence of instability (dislocation or subluxation). Rowe score, Simple Shoulder Test, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Short Form-12 (SF-12) score were also compared. RESULTS: A total of 82 shoulders in 80 patients (ABSC, n = 58; OB, n = 24) were evaluated at a mean of 39 months postoperatively. There were 4 clinical failures in the OB group (4 dislocations) and 7 clinical failures in the ABSC group (2 dislocations and 5 subluxations; P = .72 vs OB). The mean time to recurrence of postoperative instability was significantly shorter in the ABSC group (12.6 ± 2.7 months) compared with the OB group (34.2 ± 12 months; P = .04). The WOSI score in the OB group (265 ± 48.1) was better but not statistically significantly compared with the ABSC group (449.8 ± 63.8; P = .06). CONCLUSION: The time to recurrence of instability after open Bankart repair is significantly longer compared with arthroscopic Bankart repair. CLINICAL RELEVANCE: Delayed time to recurrence after open Bankart repair suggests that the open technique may be more suited to withstand the high stress and demands of a heavy-duty profession (contact athletes and heavy manual labor).