Abnormal tibial alignment is a risk factor for lateral meniscus posterior root tears in patients with anterior cruciate ligament ruptures
The purpose of this study was to identify if abnormal tibial alignment was a risk factor for lateral meniscus posterior root tears (LMPRT) in patients with acute anterior cruciate ligament (ACL) ruptures.
The medical charts of 200 patients treated for ACL ruptures between 2013 and 2016 were retrospectively reviewed and evaluated. MRI images and reports were assessed for concurrent meniscal tears. Radiographs were reviewed for tibia vara and tibial slope angles and MRI reports identifying lateral root tears were compared to intraoperative reports to determine accuracy. Multiple logistic regression models were constructed to identify potential risk factors for LMPRTs.
Of the 200 patients reviewed, a total of 97 individuals with concurrent meniscal injuries were identified. In patients sustaining a concurrent meniscal injury, there was a 4% incidence of medial meniscus posterior root tears and a 10.3% incidence of LMPRTs. Patients sustaining an ACL injury with an LMPRT were found to have greater tibia vara angles (4.2 ± 1.0 vs. 2.9 ± 1.7; p = 0.024), increased tibial slopes (12.6 ± 1.5 vs. 10.7 ± 2.9; p = 0.034), and higher BMIs (27.3 ± 2.9 vs. 25.3 ± 5.9; p = 0.034) when compared to patients without meniscus tears. There was low agreement between MRI and arthroscopic findings (kappa rate = 0.54). Multiple logistic regression analysis demonstrated that a tibia vara angle > 3 was associated with a 5.2-fold increase (95% CI 0.99–27.01; p = 0.050), and a tibial slope > 12 with a 5.4-fold increase (95% CI 1.03–28.19; p = 0.046) in LMPRTs.
Patients with greater tibia varus angles, increased tibial slopes, and higher BMIs were found to have an increased risk of LMPRTs when sustaining an ACL rupture. There was a low rate of agreement between MRI and arthroscopy in identifying LMPRTs. In patients with ACL ruptures who have abnormal tibial alignment or increased BMI, physicians should be watchful for lateral meniscus posterior root tears.
Level of evidence
KeywordsMeniscus Root tear Knee ACL Ligament Risk factors
Lateral meniscus posterior root tear
Medial meniscus posterior root tear
Anterior cruciate ligament
Body mass index
American Society of Anesthesiologists
Tibial proximal anatomic axis
Anterior tibial cortex
Posterior tibial cortex
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
The local institutional review board approved this study (IRB: Henry Ford Hospital, Detroit, MI).
- 5.Doherty DBLW (2016) Meniscal root tears: identification and repair. Am J Orthop 45:5Google Scholar
- 15.Krutsch W, Zellner J, Baumann F, Pfeifer C, Nerlich M, Angele P (2017) Timing of anterior cruciate ligament reconstruction within the first year after trauma and its influence on treatment of cartilage and meniscus pathology. Knee Surg Sports Traumatol Arthrosc 25:418–425CrossRefPubMedGoogle Scholar
- 25.Spindler KS, Bergfield JP, Andrish JA, Weiker JT, Anderson GG, Piraino TE, Richmond DW, Medendorp BJ SV (1993) Prospective study of osseous, articular, and meniscal lesions in recent anterior cruciate ligament tears by magnetic resonance imaging and arthroscopy. Am J Sports Med 21:7CrossRefGoogle Scholar