The effect of combined rupture of anterior cruciate ligament (ACL), lateral meniscus and anterolateral capsule injury and repair on tibiofemoral contact pressure

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Combined injuries of the anterior cruciate ligament (ACL), the anterolateral capsule and the lateral meniscus are common and remain challenging regarding indication of the ideal treatment to avoid secondary progression of osteoarthritis. Despite several established surgical techniques the effect of these methods on tibiofemoral pressure and joint kinematics are still insufficiently described. The purpose of this study is to determine the impact of lateral meniscus tears in combination with ACL tears and an injury of the anterolateral capsule on anterior translation and internal rotation of the knee joint. Furthermore, changes in tibiofemoral contact pressure are measured after a modified Lemaire procedure depending on the integrity of the lateral meniscus. It was hypothesized that a combined injury of the anterolateral capsule and the lateral meniscus results in a higher internal rotation and anterior translation of the tibia plateau in comparison to the intact state. Secondly, an extra-articular tenodesis in modified Lemaire technique with a concomitant tear of the lateral meniscus leads to a significant increase in contact pressure when compared to native measurements.In a biomechanical study using an industrial robot (Stäubli TX90, Stäubli und Co.) the ACL, the anterolateral capsule and the lateral meniscus are consecutively dissected to simulate a combined injury. The tibial anterior translation and internal rotation are automatically measured and analysed after each dissection step. Pressure sensitive sensor foils (Tekscan 4011 K) are used to measure the impact of ACL reconstruction and anterolateral tenodesis as well as lateral meniscus repair on tibiofemoral contact pressure. Data is analysed using two-way analysis of variance. The results of this study increase the scientific evidence level regarding the Lemaire procedure for anterolateral stabilisation of the knee and help to optimize the treatment of these patients to avoid rapid development of osteoarthritis.