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The Anterior Horn of the Medial Meniscus

An Anatomic Study of Its Insertion

Gregory C. Berlet, MD, FRCS(C) and Peter J. Fowler, MD, FRCS(C)

Fowler·Kennedy Sport Medicine Clinic, Department of Orthopaedic Surgery, The University of Western Ontario, London, Ontario, Canada

Presented at the annual meeting of The American Academy of Orthopaedic Surgeons, San Francisco, California, February 1997, the annual meeting of The Canadian Academy of Sport Medicine, Silverstar, British Columbia, Canada, February 1997, the biennial meeting of The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, Buenos Aires, Argentina, May 1997, and the annual meeting of The Canadian Orthopaedic Association, Hamilton, Ontario, Canada, June 1997.

Address correspondence and reprint requests to Peter J. Fowler, MD, FRCS(C), Fowler·Kennedy Sport Medicine Clinic, 3M Centre, The University of Western Ontario, London, Ontario N6A 3K7, Canada

A morphologic study of 48 cadaveric knees was performed to more accurately define the osseous and soft tissue anatomy of the insertion of the anterior horn of the medial meniscus. Soft tissue relationships of the anterior horn of the medial meniscus to the anterior cruciate ligament and the lateral meniscus were examined. Four tibial insertion locations of the medial meniscus were identifiable by bony landmarks. Type I insertions were located in the flat intercondylar region of the tibial plateau; type II occurred on the downward slope from the medial articular plateau to the intercondylar region; type III occurred on the anterior slope of the tibial plateau; there was no firm bony insertion of the anterior horn in type IV. The occurrence for type I was 59% (20 of 34); type II, 24% (8 of 34); type III, 15% (5 of 34); and type IV, 3% (1 of 34). The variance in insertion patterns may have clinical applications for patients with atypical anterior knee pain and for performing meniscal allograft. Type III and type IV insertions may be unable to resist peripheral extrusion of the loaded meniscus, placing it at risk for anterior subluxation and causing anterior knee pain in specific cases. Awareness of these patterns may be valuable in medial meniscus harvest and transplantation.

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