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Articles by V Musahl
Total Records ( 2 ) for V Musahl
  V Musahl , S. S Jordan , A. C Colvin , M. J Tranovich , J. J Irrgang and C. D. Harner

The purpose of the study was to compare frequency of meniscal repair to partial meniscectomy in patients undergoing anterior cruciate ligament reconstruction using the American Board of Orthopaedic Surgeons (ABOS) database.


(1) Practice patterns are similar with respect to geographic region. (2) Surgeons with fellowship training perform more meniscal repairs compared with general orthopaedic practitioners. (3) Younger patients are more likely to be treated with meniscal repair at the time of anterior cruciate ligament reconstruction. (4) The frequency of meniscal repair in conjunction with anterior cruciate ligament reconstruction has increased over time.

Study Design

Cross-sectional study; Level of evidence, 3.


Information was extracted from the ABOS database from 2002 orthopaedic surgeons who sat for the part II examination from 2003 to 2007. The database was queried for all patients who underwent anterior cruciate ligament reconstruction (Current Procedural Terminology [CPT] code 29888) without or with meniscectomy (CPT 29881) or meniscal repair (CPT 29882). Factors affecting meniscal surgery that were investigated included patient age, geographic region of practice, fellowship training, and declared subspecialty of the surgeon.


On average there were 52 000 cases per year registered in the ABOS database, approximately 1700 of whom underwent anterior cruciate ligament reconstruction. Meniscal repair was most frequently performed in the Southwest region (18.6%, P < .001) and least frequently in the Northwest region (11.3%, P < .001). Combined anterior cruciate ligament reconstruction and meniscal repair was performed significantly more often by fellowship-trained surgeons (17%) than by surgeons with other fellowship training (12%) or no fellowship training (12%, P < .001) and in patients younger than age 25 years (19%) compared with those age 40 years and older (8%, P <.001). Meniscal repair was performed in 13.9% of anterior cruciate ligament reconstructions in 2003 and in 16.4% of anterior cruciate ligament reconstructions in 2007 (P > .05).


Combined anterior cruciate ligament reconstruction with meniscal repair was more frequent for younger patients and by surgeons with sports fellowship training. Concomitant meniscal repair is performed by fellowship-trained surgeons in this study in only 18% of anterior cruciate ligament reconstructions.

  V Musahl , M Citak , P. F O'Loughlin , D Choi , A Bedi and A. D. Pearle

Background: The pivot shift is a dynamic test of knee stability that involves a pathologic, multiplanar motion path elicited by a combination of axial load and valgus force during a knee flexion from an extended position.

Purpose: To assess the stabilizing effect of the medial and lateral meniscus on anterior cruciate ligament-deficient (ACL-D) knees during the pivot shift examination.

Study Design: Controlled laboratory study.

Methods: A Lachman and a mechanized pivot shift test were performed on 16 fresh-frozen cadaveric hip-to-toe lower extremity specimens. The knee was tested intact, ACL-D, and after sectioning the medial meniscus (ACL/MM-D; n = 8), lateral meniscus (ACL/LM-D; n = 8), and both (ACL/LM/MM-D; n = 16). A navigation system recorded the resultant anterior tibial translations (ATTs). For statistical analysis an analysis of variance was used; significance was set at P < .05.

Results: The ATT significantly increased in the ACL-D knee after lateral meniscectomy (ACL/LM-D; P < .05) during the pivot shift maneuver. In the lateral compartment of the knee, ATT in the ACL-D knee increased by 6 mm after lateral meniscectomy during the pivot shift (16.6 ± 6.0 vs 10.5 ± 3.5 mm, P < .01 for ACL/LM out vs ACL out). Medial meniscectomy, conversely, had no significant effect on ATT in the ACL-D knee during pivot shift examination (P > .05). With standardized Lachman examination, however, ATT significantly increased after medial but not lateral meniscectomy compared with the ACL-D knee (P < .001).

Conclusion: Although the medial meniscus functions as a critical secondary stabilizer to anteriorly directed forces on the tibia during a Lachman examination, the lateral meniscus appears to be a more important restraint to anterior tibial translation during combined valgus and rotatory loads applied during a pivoting maneuver.

Clinical Relevance: This model may have implications in the evaluation of surgical reconstruction procedures in complex knee injuries.

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