Variations in the attachments of the medial meniscal anterior horn: a descriptive cadaveric study.

Purpose: Meniscal tears are common in Kenya, with prevalence rates ranging from 45 to 78% of intracapsular knee pathology. Diagnosis of these injuries relies on the use of both clinical signs and symptoms as well as radiological investigations. In a few instances, radiological detection could be difficult, partly because of variant attachment patterns of the medial meniscal anterior horn. Some of these unusual attachments of the anterior horn of the medial meniscus could even be mistaken for meniscal tears. There is also evidence that these variations differ from population to population. This study, therefore, aimed to determine the variant bony and ligamentous attachments of the medial meniscal anterior horn in a sample Kenyan population.

Methods: The study was conducted at the Department of Human Anatomy, University of Nairobi. Thirty-one male and female unpaired medial menisci were obtained from cadaveric specimen. The bony and ligamentous attachments were identified and recorded and photomacrographs taken.

Results: The bony attachments different from the classical textbook attachment accounted for 54.8% of the medial meniscal anterior horns. The anterior intermeniscal ligament was present in 62.3% while 16.2% showed attachment to the anterior cruciate ligament. Twenty-nine percent (29%) of the medial menisci studied did not have any ligamentous attachments.

Conclusions: The bony and ligamentous attachments of the medial meniscal anterior horn are highly variable presenting unique diagnostic and therapeutic challenges. A new classification of ligamentous attachments is thus proposed.