Risk Factors For Meniscal Root Tears in the ACL Injured Knee

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Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

Largest published series evaluating "Risk Factors For Lateral Meniscal Root Tears in the ACL Injured Knee" presented by Dr Adnan Saithna, expert in ACL reconstruction, Overland Park, Kansas at the 2019 Arthroscopy Association Annual Meeting

Health & Medicine

RiskfactorsforLateralMeniscusPosteriorRoot
TearsinAnteriorCruciateLigamentInjuredKnees:
AnEpidemiologicalAnalysisof3956Patients.
Adnan Saithna1,2, MD, Cesar Praz3, MD, Thais Dutra Vieira3, MD, Nikolaus
Rosentiel3, MD, Vikram Kandhari3, MS, DNB, Helder Nogueira3, MD and
Bertrand Sonnery Cottet3, MD
1. Sano Orthopedics, KS & MO, USA
2. Kansas City University of Medicine and Biosciences, MO, USA
3. Santy Clinic, FIFA Centre of Medical Excellence, Lyon, France

Disclosure
Information
Consultant
 AS and BSC are consultants for Arthrex
 AS has provided consultancy for Smith & Nephew
in the past 12 months
Other
 BSC receives royalties from Arthrex

Background
 Meniscal root tears result in loss of distribution
of hoop forces, significantly increased contact
pressures, and an increased risk of early
degenerative change
 Missed diagnoses can occur due to limitations
of MRI and pre-operative physical examination

Objective
 To evaluate the incidence of lateral meniscus
posterior root tears (LMPRT) in a large series of
patients undergoing ACL reconstruction and to
determine important risk factors

Methods
 All patients who underwent primary or revision
ACL reconstruction by a single surgeon
between January 2011 and April 2018 were
considered for study eligibility. From this
overall population, all patients who underwent
repair of an LMPRT were identified.
 The epidemiology of LMPRT was defined by
the incidence within the study population,
stratified by key demographic parameters.
 Potentially important risk factors for the
presence of LMPRT were evaluated in
multivariate logistic regression analysis.

Results
 A total of 3956 patients undergoing ACL
reconstruction were included in the study. A
LMPRT was identified and repaired in 262
patients (6.6%).

Risk factors
identified in
multivariate
analysis

Discussion
 Large sample size of current study gives a
reliable estimate of true incidence of LMPRT
compared to previous studies
 The higher frequency in more acute injuries
was a reflection of clinical practice to expedite
cases with meniscal pathology
 Confirmation of previous reports that contact
sports is an important risk factor
 Identification of concomitant medial meniscal
tears as a risk factor for LMPRT supports the
concept that these injuries are typically higher
energy

 The incidence of LMPRT was 6.6% in a
large series of patients undergoing ACL
reconstruction. Participation in contact
sports and the presence of a concomitant
medial meniscal tear were demonstrated
to be important independent risk factors.
 The presence of these risk factors should
raise the index of suspicion of this injury
pattern.
Conclusion

 The full article is available here:
 Risk Factors for Lateral Meniscus Posterior RootTears in
the Anterior Cruciate Ligament-Injured Knee: An
EpidemiologicalAnalysis of 3956 Patients From the SANTI
Study Group.
 Am J Sports Med. 2019 Mar;47(3):598-605. doi:
10.1177/0363546518818820. Epub 2019 Jan 16.
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ACL Repair Vs Reconstruction, AZBSC Orthopedics, Scottsdale, AZ

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

ACL repair offer several potential advantages over ACL reconstruction (including quicker rehabilitation, less invasive surgery, reduced operative time, avoidance of donor site morbidity, better proprioception, better forgotten joint scores and the simplicity of revision to ACL reconstruction if the repair fails). This study compares the clinical outcomes of ACL Repair vs Reconstruction. It demonstrates several advantages of ACL repair including superior muscle strength at 6 months, and significantly better forgotten joint scores (FJS-12 scores) as well as non-inferiority with respect to knee laxity parameters and the IKDC score. Dr Adnan Saithna is an expert in ACL surgery in Scottsdale, Phoenix and Glendale, Arizona. To read about his other work on ACL Repair please see the following references: Praz C, Kandhari VK, Saithna A, Sonnery-Cottet B. ACL rupture in the immediate build-up to the Olympic Games: return to elite alpine ski competition 5 months after injury and ACL repair. BMJ Case Rep. 2019 Mar 15;12(3) Ferreira A, Saithna A, Carrozzo A, Guy S, Vieira TD, Barth J, Sonnery-Cottet B. The Minimal Clinically Important Difference, Patient Acceptable Symptom State, and Clinical Outcomes of Anterior Cruciate Ligament Repair Versus Reconstruction: A Matched-Pair Analysis From the SANTI Study Group. Am J Sports Med. 2022 Nov;50(13):3522-3532 Kandhari V, Vieira TD, Ouanezar H, Praz C, Rosenstiel N, Pioger C, Franck F, Saithna A, Sonnery-Cottet B. Clinical Outcomes of Arthroscopic Primary Anterior Cruciate Ligament Repair: A Systematic Review from the Scientific Anterior Cruciate Ligament Network International Study Group. Arthroscopy. 2020 Feb;36(2):594-612 Delaloye JR, Murar J, Vieira TD, Saithna A, Barth J, Ouanezar H, Sonnery-Cottet B. Combined Anterior Cruciate Ligament Repair and Anterolateral Ligament Reconstruction. Arthrosc Tech. 2018 Dec 10;8(1):e23-e29. Risk S, Saithna A, Ferretti A, et al. The modern-day ACL surgeon’s armamentarium should include multiple surgical approaches including primary repair, augmentation, and reconstruction: A letter to the Editor. https://www.jisakos.com/article/S2059-7754(23)00465-0/fulltext

Factors Influencing the Outcomes of a Validated Return to Sports Test Battery...

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

This study analyzed factors influencing scores on the K-STARTS return to sport test battery in 676 patients who underwent ACL reconstruction. The only factor found to significantly influence scores above the minimal detectable change threshold was completion of a specific return to sport program in addition to standard rehabilitation, which resulted in improved K-STARTS scores at 6 months post-surgery compared to standard rehabilitation alone. No other factors such as age, sex, graft type, or meniscal injury status significantly influenced scores.

Randomized Controlled Trial Comparing Isolated Bone-Patellar Tendon-Bone Graf...

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

Professional Athletes are at Higher Risk of Septic Arthritis after ACL Recons...

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

Current Concepts in Orthopedic Sports Medicine

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

Combined ACL and Anterolateral Ligament Reconstruction in Professional Athletes

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

Surgical Management of the ACL-Injured Elite Athlete: Current Concepts in 2018

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

Diagnosis of Anterolateral Knee Injury

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

Clinical Results of Combined ACL and Anterolateral Ligament Reconstruction: S...

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

Anterolateral Ligament Reconstruction Is Associated With Significantly Reduce...

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

Winner of the Richard O'Connor Research Award from the Arthroscopy Association of North America 2017. This study demonstrates major improvement in the outcome of ACL reconstruction when an extra-articular procedure (ALL reconstruction) is also performed. The full manuscript is published in AJSM. Anterolateral Ligament Reconstruction Is Associated With Significantly Reduced ACL Graft Rupture Rates at a Minimum Follow-up of 2 Years: A Prospective Comparative Study of 502 Patients From the SANTI (Scientific ACL NeTwork International) Study Group

3D CT Evaluation Of Tunnel Positioning In ACL Reconstruction Using The Single...

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

3D-MRI Evaluation of the Anterolateral Ligament: An Evaluation of ACL Deficie...

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

Re-operation Rates After Combined ACL and Anterolateral Ligament Reconstruction

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

Popliteus is a safe location for all-inside meniscal repair devices in poster...

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

Current Concepts in the Diagnosis and Management of Long Head of Biceps Tendo...

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

How to improve the biology and healing of rotator cuff repair

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

Rotator cuff repair has high failure rates. Augmentation techniques aim to improve healing biology but evidence is limited. Steroid injections impair healing while diabetes control and smoking cessation may optimize patient factors. Footprint preparation requires care to not weaken fixation. Patch augmentation shows promise with lower re-tear rates in some studies compared to historical controls, but evidence is mainly from lower quality studies. Further high-quality research is needed to establish the role of augmentation techniques like platelet-rich plasma, stem cells, and scaffolds.

Biological Augmentation Of Rotator Cuff Tears

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

Rotator cuff tears are a very common cause of shoulder pain. Surgery is very successful in improving pain but biological augmentation is aimed at improving the healing rate. Amniotic membrane allografts, PRP (platelet rich plasma) and stem cells are all currently popular options. This study is an In vitro analysis of amniotic membrane allograft as a potential agent for biological augmentation of rotator cuff repair performed by Dr Adnan Saithna, Orthopedic Surgeon, AZBSC Orthopedics

Simultaneous Bilateral ACL Reconstruction

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

Shoulder arthroscopy does not adequately visualise pathology of the LHB tendon

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

This document challenges the assumption that shoulder arthroscopy is an adequate gold standard for diagnosing long head biceps (LHB) tendon pathology. A cadaver study found that arthroscopy only allows visualization of a small portion of the extra-articular LHB tendon. A systematic review found the rate of missed LHB tendon diagnoses with arthroscopy alone is 30-50%. The document concludes that arthroscopy does not adequately evaluate the full LHB tendon for pathology and new arthroscopic techniques are needed to improve diagnosis.

Inside-Out Radiofrequency Ablation Technique For Rapid Localization of the Lo...

Adnan Saithna - Orthopedic Surgeon, Scottsdale, Arizona

This study evaluated a novel "inside-out" radiofrequency ablation technique for rapidly localizing the long head of the biceps tendon (LHBT) during arthroscopic biceps tenodesis. The technique was performed on a cadaver specimen and involved creating an anterosuperior portal near the biceps pulley under arthroscopic visualization, inserting a radiofrequency device into the bicipital groove, and dividing the transverse humeral ligament from distal to proximal under direct vision. Open dissection confirmed the technique caused no injury to the rotator cuff tendons. This technique offers a rapid method for LHBT localization without extensive bursectomy to visualize the tendon and may reduce risks of i

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