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Lilly S1, Seeber GH2,3, Smith MP4, McGaugh JM5, James CR6, Brismée J-M3, Gilbert KK3, Sizer Jr. PS3
1MD Anderson Cancer Center, Houston, United States, 2University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany, 3Texas Tech University Health Sciences Center, Center for Rehabilitation Research, Lubbock, United States, 4Sages College, Department of Biology, Troy, United States, 5University of Texas Medical Branch, School of Health Professions, Department of Physical Therapy, Galveston, United States, 6Texas Tech University Health Sciences Center, Lubbock, United States
Background: Anterior knee pain during extension may be related to a meniscal movement restriction and subsequent irritation during loading. Orthopedic manual therapy techniques designed to facilitate meniscotibial and meniscofemoral movement have been proposed but not yet scientifically evaluated.
Purpose: To investigate if a manually applied posterior force to the tibia with the femur stabilized will result in significant meniscotibial displacement.
Methods: Eight (8) un-embalmed cadaveric knee specimens were mounted in a custom apparatus. Markers were placed in the medial meniscus, tibia, and femur. The tibia was posteriorly mobilized in two randomized knee positions (0° and 25° of flexion), using three randomly assigned loads (44.48N, 88.96N, 177.93N). Markers were photographed, digitally measured, and analyzed.
Results: All load x position conditions produced meniscus anterior displacement on the tibia, where the displacement was significant [t (7) = -3.299; p= 0.013] at 0° loaded with 177.93N (mean 0.41±0.35 mm). The results of 2(position)x3(load) repeated measures ANOVA for meniscotibial displacement produced no significant main effects for load [F(2,14)=2.542;p =.114)or position [F(1,7)=0.324,p=.587]. All load x position conditions produced significant posterior tibial and meniscal displacement on the femur. The 2(position)x3(load) repeated measures ANOVA revealed a significant main effect for load for both femoral marker displacement relative to the tibial axis [F(2,14)=77.994; p .001] and meniscal marker displacement relative to the femoral marker [F(2,14)=83.620;p .001].
Conclusion(s): Use of a mobilization technique to target the meniscotibial interface appears to move the meniscus anteriorly on the tibia. It appears that this technique may be most effective at the end range position. Future research should examine the same mobilizing technique in live subjects with anterior knee pain during passive knee extension.
Implications: These findings might serve as a segue for understanding how to restore appropriate meniscotibial arthrokinematics in patients presenting with anterior knee pain related to meniscal restraint and subsequent irritation. The findings suggest that posterior tibial mobilization in an end-range extension using a substantial force may produce medial meniscus anterior horn translation in an anterior direction with respect to the tibial plateau. This technique may be most applicable in patients presenting with localized anterior knee pain during passive terminal knee joint extension.
Keywords: Anterior knee pain, Meniscus, Orthopedic Manual Therapy
Funding acknowledgements: No funding has been received for this study.
Purpose: To investigate if a manually applied posterior force to the tibia with the femur stabilized will result in significant meniscotibial displacement.
Methods: Eight (8) un-embalmed cadaveric knee specimens were mounted in a custom apparatus. Markers were placed in the medial meniscus, tibia, and femur. The tibia was posteriorly mobilized in two randomized knee positions (0° and 25° of flexion), using three randomly assigned loads (44.48N, 88.96N, 177.93N). Markers were photographed, digitally measured, and analyzed.
Results: All load x position conditions produced meniscus anterior displacement on the tibia, where the displacement was significant [t (7) = -3.299; p= 0.013] at 0° loaded with 177.93N (mean 0.41±0.35 mm). The results of 2(position)x3(load) repeated measures ANOVA for meniscotibial displacement produced no significant main effects for load [F(2,14)=2.542;p =.114)or position [F(1,7)=0.324,p=.587]. All load x position conditions produced significant posterior tibial and meniscal displacement on the femur. The 2(position)x3(load) repeated measures ANOVA revealed a significant main effect for load for both femoral marker displacement relative to the tibial axis [F(2,14)=77.994; p .001] and meniscal marker displacement relative to the femoral marker [F(2,14)=83.620;p .001].
Conclusion(s): Use of a mobilization technique to target the meniscotibial interface appears to move the meniscus anteriorly on the tibia. It appears that this technique may be most effective at the end range position. Future research should examine the same mobilizing technique in live subjects with anterior knee pain during passive knee extension.
Implications: These findings might serve as a segue for understanding how to restore appropriate meniscotibial arthrokinematics in patients presenting with anterior knee pain related to meniscal restraint and subsequent irritation. The findings suggest that posterior tibial mobilization in an end-range extension using a substantial force may produce medial meniscus anterior horn translation in an anterior direction with respect to the tibial plateau. This technique may be most applicable in patients presenting with localized anterior knee pain during passive terminal knee joint extension.
Keywords: Anterior knee pain, Meniscus, Orthopedic Manual Therapy
Funding acknowledgements: No funding has been received for this study.
Topic: Musculoskeletal: lower limb
Ethics approval required: No
Institution: Texas Tech University Health Sciences Center
Ethics committee: Anatomy SubCommittee at TTUHSC
Reason not required: This project was completed at the Texas Tech University Health Sciences Center (TTUHSC) gross anatomy lab. Such cadaveric research did not require ITB approval or oversight at TTUHSC. Investigations using cadaveric specimen were conducted in accordance with TTUHSC policies and regulations as determined by the Texas State Anatomical Board (TSAB). Any violations at TTUHSC are internally reviewed by an anatomical research committee and the review is reported to that TSAB, who then externally reviews the violation. There were no violations related to this study.
All authors, affiliations and abstracts have been published as submitted.
