Ibrahim Akkawi

Does meniscus removal affect ACL-deficient knee laxity? An in vivo study

PurposeThe purpose of the present study was to determine, in vivo, the effect of different types of meniscectomy on an ACL-deficient knee.MethodsUsing a computer-assisted navigation system, 56 consecutive patients (45 men and 11 women) were subjected to a biomechanical testing with Lachman test (AP30), drawer test (AP90), internal/external rotation test, varus/valgus rotation test and pivot-shift test. The patients were divided into three groups according to the status of the medial meniscus. Group BH, 8 patients with bucket-handle tear of medial meniscus underwent a subtotal meniscectomy; Group PHB, 19 patients with posterior horn body of medial meniscus tear underwent a partial meniscectomy; and Group CG with isolated ACL rupture, as a control group, with 29 patients.ResultsA significant difference in anterior tibial translation was seen at 30 grades and in 90 grades between BH and PHB groups compared to the CG. In response to pivot-shift test, no significant differences in terms of AREA and POSTERIOR ACC were found among the three groups (n.s). Concerning the anterior displacement of the pivot shift a statistically significant differences among the three tested groups was found.ConclusionThe present study shows that meniscal defects significantly affect the kinematics of an ACL-deficient knee in terms of anterior tibial translation under static and dynamic testing.

Revision Total Knee Arthroplasty

Total knee arthroplasty (TKA) is one of the most successful orthopaedic procedures performed today. This is due to the substantial pain relief and restoration of function after TKA. As result of its success [15, 21], indications for TKA have included younger and more active patients. Therefore, the number of revision TKAs is also rising with a projected increase of 601 % from 2005 to 2030 [14]. Although the results of primary TKAs are well documented with implant survivorship at 15 years greater than 95 % [29], the results of revision procedures are less predictable and encouraging with an 82 % survivorship at 12 years. Predominant revision failure modes include infection (46 %), aseptic loosening (19 %) and instability (13 %) [28].