Annelisse Cuellar-Montes

All Publications

• Pediatric Meniscotibial Ligament Complex Anatomy and Biomechanics. Orthopaedic journal of sports medicine van Deursen, W. H., Johnstone, T. M., Cuellar-Montes, A., Baird, D. R., Chan, C. K., Hollyer, I., Rohde, M. S., Tompkins, M., Ellis, H. B., Ganley, T. J., Yen, Y. M., Schmitz, M. R., Pham, N. S., Sherman, S. L., Levenston, M., Shea, K. G. 2025; 13 (9): 23259671251367060

  Abstract

  Meniscal repair is increasingly performed in pediatric patients, with capsular-based techniques remaining the gold standard despite limitations such as high failure rates and risk of meniscal extrusion. Recent studies highlight the potential role of accessory knee ligaments in improving meniscal stability and repair outcomes. The meniscotibial ligament complex (MTLC) has emerged as a potential area of interest to produce more normal anatomic and biomechanical meniscal function in meniscal repair.To evaluate the native anatomy and biomechanical strength of the MTLC of the medial and lateral meniscus of pediatric knees.Descriptive laboratory study.Fourteen fresh-frozen pediatric human knees (mean age, 7.5 years; range, 5-10 years; 6 male, 8 female) were used in this study. The depth of the recess between the MTLC and the meniscocapsular complex was measured. Subsequently, the medial and lateral menisci were divided into approximate thirds, creating anterior, central, and posterior testing zones for each meniscus. Each meniscus/MTLC complex underwent monotonic load-to-failure testing on an Instron 5944 test frame with a 2-kN load cell with load applied superiorly. Biomechanical properties were analyzed using linear mixed models with donor as a random factor and aspect (medial/lateral) and position (anterior/central/posterior) as fixed factors.The posterior recess depth was significantly larger (mean, 5.4 mm; 95% CI, 4.6-6.3 mm) than anterior (mean, 3.4 mm; 95% CI, 2.6-4.2 mm) (P = .049). Maximal load to failure in the posterior MTLC (mean, 93.5 N; 95% CI, 80.0-107.0 N) was significantly higher than anterior (mean, 69.2 N; 95% CI, 56.7-81.7 N) (P = .01).This study defines a clear space in which the MTLC is distinct from the joint capsule, which is deepest in the posterior third of the medial and lateral meniscus. Our results demonstrate that the posterior region of the MTLC can withstand higher loads than the anterior region in pediatric knees.These findings offer foundational insights into the native anatomy and biomechanics of the MTLC, guiding future studies involving the MTLC in meniscal repair. This knowledge may be particularly relevant to ramp lesions, other posterior meniscal tear patterns, and meniscal transplants.

  View details for DOI 10.1177/23259671251367060

  View details for PubMedID 40949534

  View details for PubMedCentralID PMC12426389

• The Role of Laser Therapies in Common Cutaneous Vascular Anomalies in Pediatric Populations Steinberg, C., Cuellar-Montes, A., Teng, J. ELSEVIER SCIENCE INC. 2025: e10

  View details for Web of Science ID 001549725200036

• Screws or Sutures? A Pediatric Cadaveric Study of Tibial Spine Fracture Repairs. The American journal of sports medicine Johnstone, T. M., Baird, D. W., Cuellar-Montes, A., van Deursen, W. H., Tompkins, M., Ganley, T. J., Yen, Y. M., Ellis, H. B., Chan, C. K., Green, D. W., Sherman, S. L., Shea, K. G. 2023: 3635465231181059

  Abstract

  Tibial spine fractures are common in the pediatric population because of the biomechanical properties of children's subchondral epiphyseal bone. Most studies in porcine or adult human bone suggest that suture fixation performs better than screw fixation, but these tissues may be poor surrogates for pediatric bone. No previous study has evaluated fixation methods in human pediatric knees.To quantify the biomechanical properties of 2-screw and 2-suture repair of tibial spine fracture in human pediatric knees.Controlled laboratory study.Cadaveric specimens were randomly assigned to either 2-screw or 2-suture fixation. A standardized Meyers-Mckeever type 3 tibial spine fracture was induced. Screw-fixation fractures were reduced with two 4.0-mm cannulated screws and washers. Suture-fixation fractures were reduced by passing 2 No. 2 FiberWire sutures through the fracture fragment and the base of the anterior cruciate ligament. Sutures were secured through bony tunnels over a 1-cm tibial cortical bridge. Each specimen was mounted at 30° of flexion. A cyclic loading protocol was applied to each specimen, followed by a load-to-failure test. Outcome measures were ultimate failure load, stiffness, and fixation elongation.Twelve matched pediatric cadaveric knees were tested. Repair groups had identical mean (8.3 years) and median (8.5 years) ages and an identical number of samples of each laterality. Ultimate failure load did not significantly differ between screw (mean ± SD, 143.52 ± 41.9 7 N) and suture (135.35 ± 47.94 N) fixations (P = .760). Screws demonstrated increased stiffness and decreased elongation, although neither result was statistically significant at the .05 level (21.79 vs 13.83 N/mm and 5.02 vs 8.46 mm; P = .076 and P = .069, respectively).Screw fixation and suture fixation of tibial spine fractures in human pediatric tissue were biomechanically comparable.Suture fixations are not biomechanically superior to screw fixations in pediatric bone. Pediatric bone fails at lower loads, and in different modes, compared with adult cadaveric bone and porcine bone. Further investigation into optimal repair is warranted, including techniques that may reduce suture pullout and "cheese-wiring" through softer pediatric bone. This study provides new biomechanical data regarding the properties of different fixation types in pediatric tibial spine fractures to inform clinical management of these injuries.

  View details for DOI 10.1177/03635465231181059

  View details for PubMedID 37382335