Aymeric Laporte's uncommon right knee lateral meniscus tear: Why he dodged a major bullet

Manchester City defender Aymeric Laporte - billed as the best left-sided centerback in the world by Coach Pep Guardiola - went down with a “lateral meniscus tear of the right knee” on August 31st vs Brighton that required surgery.

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In this article, I’ll delve into the injury specifics, the surgery, and Laporte’s return timeline, including why he very likely dodged a career-ruining bullet. If you prefer a video format, click on the video below but if not, keep scrolling.

The injury

Anatomy

The meniscus is a dual-crescent shaped, force absorbing, friction reducing piece of cartilage that sits between the femur (thigh bone) and tibia (shin bone) within the knee joint. One half sits on the inner (medial) aspect of the knee and the other sits on the outer (lateral) aspect of the knee.

Lateral meniscal tears are much rarer than medial meniscal tears and, as in Laporte’s case, tend to happen from a direct trauma to the knee. Although many meniscus’s tears don’t require surgery, Man City’s medical staff decided surgery was the best option moving forward.

The surgery & return timeline

There are two surgical options for meniscal tears: Removing the damaged cartilage - known as a meniscectomy - or repairing the damaged cartilage - known as a meniscal repair.

The latter is only an option when the tear occurs in a part of the meniscus that is vascularized, meaning it has blood supply. Repaired tissue cannot heal without blood flow.

Meniscal blood supply


As you move from the outer (peripheral) part of the meniscus to the inner (central) part of the meniscus, there’s less and less and blood supply - schematically represented as red, pink, and white zones.

To that point, meniscus injuries are like real estate - it’s all about location location location. A large bucket handle tear on the periphery of the meniscus would be more amenable to repair than a smaller tear that sits centrally.

Laporte likely had a...

Based on Man City ruling Laporte out for at least the rest of 2020 and Coach Guardiola stating that he expects Laporte to be out at least five to six months, it’s nearly certain that Laporte had a lateral meniscal repair.

That timeline lines up with the research that shows an average 5.6 month return to play (RTP) for elite athletes after meniscal repair as compared to an average six week RTP after a meniscectomy (partial removal of the meniscus). The difference in timeline is attributed to the considerable extra time needed for the tissue to heal after being repaired. Assuming Laporte’s RTP aligns with the average, he’ll be back in mid-February.

Why Laporte dodged a major bullet

The good news

Laporte is extremely fortunate that his tear was repairable. Lateral meniscal tears that require removal (meniscectomy) are very concerning injuries because they often lead to arthritic changes in less than five years compared to medial meniscectomies where those changes can take as long as 30 years to manifest.

Medial vs lateral differences

That stark contrast is due to anatomical and biomechanical differences in the lateral (outer) and medial (inner) compartments of the knee joint, respectively. The medial knee joint is larger and more stable because the outwardly rounded (convex) femur (thigh bone) sits neatly into the inwardly rounded (concave) tibia (shin bone). This convex-concave bony relationship is akin to a ball sitting into a cup. On the other hand, the lateral side of the knee joint is smaller and less stable because both the femur and tibia are convex (outwardly rounded) - like a ball sitting on another ball - with increased translation (movement) and higher shear forces along that side of the joint.

Meniscal function

Accordingly, the meniscus on the lateral side plays a substantially different role than it does on the medial side. On the smaller, less stable, higher sheer force lateral side, the meniscus serves to help mitigate each of these aspects - providing stability while increasing joint surface area to help distribute and absorb the higher stress of the shear forces. That’s why removing a piece of the lateral meniscus can lead to devastating changes in the knee.

Meniscus repair outcomes

On the other hand, the research on meniscal repairs (although relatively new) shows that repairs - regardless of lateral or medial - result in very good outcomes with athletes typically returning to high level function without any significant long-term changes at the knee.

Additionally, with the support of an elite medical and rehab team, Laporte will be going through methodical rehab protocols and ongoing strength and conditioning to reinforce range of motion, strength of the knee, eliminate potential compensations, and continue to build his overall fitness. 

CB conundrum...

In the meantime, look for Pep to continue to try and find a reliable CB pairing and, based on Laporte’s ongoing recovery and how the team is shaping up defensively, potentially trying to find a CB in the January window who can fill-in and provide depth at a position which has thinned out considerably for Man City over the past couple seasons. Depth that has recently taken yet another severe blow with CB Jon Stones injuring his quad and out for up to six weeks.

And that’s a wrap! Thanks for reading. Make sure to subscribe below for weekly articles and never miss an update. In the meantime, also feel free to reach out to me - rsbrar@3cbperformance.com - with any questions or comments.