Chronic Clicking and Locking: Anterior Horn Tear CAPT Matthew T. - - PowerPoint PPT Presentation

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chronic clicking and locking anterior horn tear
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Chronic Clicking and Locking: Anterior Horn Tear CAPT Matthew T. - - PowerPoint PPT Presentation

Oct 28, 2022 280 likes •520 views

Chronic Clicking and Locking: Anterior Horn Tear CAPT Matthew T. Provencher, MD, MC USNR Shoulder, Knee and Sports Surgery The Steadman Clinic & Steadman Philippon Research Institute Chairman, Vail Health IRB Professor of Surgery, USUHS

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Chronic Clicking and Locking: Anterior Horn Tear

CAPT Matthew T. Provencher, MD, MC USNR Shoulder, Knee and Sports Surgery The Steadman Clinic & Steadman Philippon Research Institute Chairman, Vail Health IRB Professor of Surgery, USUHS

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SLIDE 2

Disclosures

  • Royalties - Arthrex
  • Stock - None
  • Consultant - Arthrex; JRF
  • Research Support -

AOSSM Grant (2005); AANA Research Grant (2008; 2006); OREF Grants (2002; 2004); BUMED (2009; 2012; 2014)

  • Editorial Boards -

Elsevier (Arthroscopy - Asst. Editor in Chief; JSES), JBJS, JAAOS, SLACK (Orthopaedics, JKS), Sage (AJSM)

  • Board Memberships -

AOSSM (Board of Directors, Research); SOMOS (Past Pres.); AAOS (Program; Annual Meeting); BOS/BOC (Research); ISAKOS (UE); AANA (Program/Education); ASES (Program; Membership; Technology)

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SLIDE 3

Case

  • 17-Year-Old with Chronic Clicking

and Locking

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SLIDE 4

Lateral Meniscal Root Anatomy

  • Anterior lateral distance from center of ACL
  • 5.0 mm posteromedial
  • Anterior lateral distance from apex of

lateral tibial eminence

  • 14.4 mm posterolateral
  • AL root attachment
  • mean area of 140.7 mm2
  • Inserted deeply beneath the ACL in all

specimens. Overlap of the ACL on the AL root averaged 88.9 mm2, 63.2%

2014

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SLIDE 5
  • Anterior medial distances from apex of tibial tuberosity
  • 27.0 mm lateral
  • 27.0 mm distal
  • anterior medial distance from apex of medial tibial eminence
  • 27.5 mm posterior
  • AM root attachment
  • mean area of 110.4 mm2
  • central attachment 56.3 mm2

Lateral Meniscal Root Anatomy

2014

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SLIDE 6
  • Anterior lateral (AL) meniscal

root overlaps with ACL footprint

  • Tibial tunnel reaming of ACL

tunnel decreases AL root attachment area and ultimate failure strength

✴ Laterally placed ACL tibial

tunnels should be avoided

ACL Tibial Tunnel Reaming

2014

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SLIDE 7
  • Safranin O-stained coronal sections to access type I vs. II

collagen signal distribution and density

2016

Type II collagen density of the LMAI was higher than that

  • f the ACL tibial insertion and ACL-LM transition zone
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SLIDE 8
  • Mean % of ACL

ALMR:

  • coronal plane,

41.0%

  • sagittal, 53.9%
  • % of insertion
  • verlap

significantly higher in sagittal plane

2017 ACL ALMR

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SLIDE 9

Often Iatrogenic - How does it present clinically?

2016

ruptured ACL remnant LMAI

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SLIDE 10

Often Iatrogenic - How does it present clinically?

2016

bridging tissue ACL remnant edge ACL remnant footprint

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SLIDE 11

Often Iatrogenic - How does it present clinically?

2016

Bundle guide pins Lateral shift of the tendon grafts Distance between grafts and medial intercondylar ridge

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SLIDE 12

Often Iatrogenic - How does it present clinically?

2016

Post-op

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SLIDE 13

Often Iatrogenic - How does it present clinically?

2016

Post-op

proximal shift

  • f the

LMAI tendon graft tendon graft

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SLIDE 14

Often Iatrogenic - How does it present clinically?

2016

Post-op

tendon graft tendon graft proximal shift

  • f the

LMAI proximal shift

  • f the

LMAI

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SLIDE 15

Anterior Horn LM Repair Technique

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SLIDE 16

Prepare - Cannula Insert - Sutures

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SLIDE 17

Anterior Horn LM Repair Technique

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SLIDE 18

Double Row Repair of Root

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SLIDE 19

Showing ACL Location to Avoid

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Thank You!