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Berk AN, Cregar WM, Wang S, Habet NA, Ifarraguerri AM, Trofa DP, Piasecki DP, Fleischli JE, Saltzman BM. The Effect of Lower Limb Alignment on Tibiofemoral Joint Contact Biomechanics after Medial Meniscus Posterior Root Repair: A Finite-Element Analysis. J Am Acad Orthop Surg 2024; 32:e558-e567. [PMID: 38669669 DOI: 10.5435/jaaos-d-23-00702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/25/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The purpose of this study was to determine how variations in lower limb alignment affect tibiofemoral joint contact biomechanics in the setting of medial meniscus posterior root tear (MMPRT) and associated root repair. METHODS A finite-element model of an intact knee joint was developed. Limb alignments ranging from 4° valgus to 8° varus were simulated under a 1,000 N compression load applied to the femoral head. For the intact, MMPRT, and root repair conditions, the peak contact pressure (PCP), total contact area, mean and maximum local contact pressure (LCP) elevation, and total area of LCP elevation of the medial tibiofemoral compartment were quantified. RESULTS The PCP and total contact area of the medial compartment in the intact knee increased from 2.43 MPa and 361 mm 2 at 4° valgus to 9.09 MPa and 508 mm 2 at 8° of varus. Compared with the intact state, in the MMPRT condition, medial compartment PCP was greater and the total contact area smaller for all alignment conditions. Root repair roughly restored PCPs in the medial compartment; however, this ability was compromised in knees with increasing varus alignment. Specifically, elevations in PCP relative to the intact state increased with increasing varus, as did the total contact area with LCP elevation. After root repair, medial compartment PCP remained elevated above the intact state at all degrees tested, ranging from 0.05 MPa at 4° valgus to 0.27 MPa at 8° of varus, with overall PCP values increasing from 2.48 to 9.09 MPa. For varus alignment greater than 4°, root repair failed to reduce the total contact area with LCP elevation relative to the MMPRT state. DISCUSSION Greater PCPs and areas of LCP elevation in varus knees may reduce the clinical effectiveness of root repair in delaying or preventing the development of tibiofemoral osteoarthritis.
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Affiliation(s)
- Alexander N Berk
- From the OrthoCarolina-Sports Medicine Center, Charlotte, NC (Berk, Cregar, Ifarraguerri, Piasecki, Fleischli, and Saltzman), the OrthoCarolina Research Institute, Charlotte, NC (Berk, Cregar, Ifarraguerri, Piasecki, Fleischli, and Saltzman), the Atrium Health-Musculoskeletal Institute, Charlotte, NC (Berk, Cregar, Wang, Habet, Ifarraguerri, Piasecki, Fleischli, and Saltzman), and the Columbia University Medical Center-Department of Orthopaedics, New York Presbyterian, New York, NY (Trofa)
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Çakır GH, Mutlu İ. A comparison of stress, contact pressure, and contact area on menisci in re-injury mechanisms after reconstruction of the anterior cruciate ligament with autograft and synthetic graft: a finite element study. INTERNATIONAL ORTHOPAEDICS 2023; 47:2487-2496. [PMID: 37449986 DOI: 10.1007/s00264-023-05881-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The anterior cruciate ligament (ACL) is crucial in maintaining knee stability. Some motion mechanisms, which are common in sports, cause excessive load to be passed on the ACL. In non-contact ACL injuries, the ACL cannot sustain the high stress and becomes injured or ruptures in the valgus-external rotation mechanism (VERM) and varus-internal rotation mechanism (VIRM). The mechanical strength of the grafts used to repair the torn ligament varies. The purpose of this study is to look at the alterations in the menisci after anterior cruciate ligament repair with autografts and synthetic grafts in cases of non-contact re-injury mechanisms. METHODS In the finite element analysis, VERM and VIRM motions of the injury were simulated with different ACL graft materials. During the simulations of these mechanism motions with polyethylene terephthalate (PET) and patellar tendon (PT), the contact pressures, contact areas, and von mises stress values created in the medial and lateral meniscus were compared. RESULTS The peak contact pressures on the menisci during the VERM are higher than the peak contact pressures during the VIRM, except for one variation. The peak contact pressure of the medial meniscus is almost the same for both graft materials and mechanisms. Furthermore, the peak contact pressures in the menisci are higher than in the VERM. For all injury mechanisms, the peak contact stresses on the lateral meniscus are higher than on the medial meniscus. CONCLUSIONS The findings suggest that VERM can induce further knee joint injury. It was found that the PET will lessen the pressure on the menisci even more. It is also advantageous since it does not damage the anterior extremities and transmits less pressure to the menisci. In conclusion, using a high-strength ACL is healthier for the menisci. Even though synthetic grafts are not clinically preferred, the study demonstrates that enhancing the material properties of synthetic grafts will increase the chance of their use in the future, based on the current results.
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Affiliation(s)
- Gül Hilal Çakır
- Department of Biomedical Engineering, Kocaeli University, Umuttepe Campus, Izmit, Kocaeli, Turkey.
| | - İbrahim Mutlu
- Department of Biomedical Engineering, Kocaeli University, Umuttepe Campus, Izmit, Kocaeli, Turkey
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Sukopp M, Shemesh M, Pruech E, Linder-Ganz E, Hacker S, Condello V, Schwer J, Ignatius A, Dürselen L, Seitz AM. Free-floating medial meniscus implant kinematics do not change after simulation of medial open-wedge high tibial osteotomy and notchplasty. J Exp Orthop 2023; 10:13. [PMID: 36757624 PMCID: PMC9911568 DOI: 10.1186/s40634-023-00576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
PURPOSE The purpose of this in-vitro study was to examine the kinematics of an artificial, free-floating medial meniscus replacement device under dynamic loading situations and different knee joint states. METHODS A dynamic knee simulator was used to perform dynamic loading exercises on three neutrally aligned and three 10° valgus aligned (simulating a medial openwedge high tibial osteotomy - MOWHTO) left human cadaveric knee joints. The knee joints were tested in three states (intact, conventional notchplasty, extended notchplasty) while 11 randomised exercises were simulated (jump landing, squatting, tibial rotation and axial ground impacts at 10°, 30° and 60° knee joint flexion) to investigate the knee joint and implant kinematics by means of rigidly attached reflective marker sets and an according motion analysis. RESULTS The maximum implant translation relative to the tibial plateau was < 13 mm and the maximum implant rotation was < 19° for all exercises. Both, the notchplasties and the valgus knee alignment did not affect the device kinematics. CONCLUSIONS The results of the present in-vitro study showed that the non-anchored free-floating device remains within the medial knee joint gap under challenging dynamic loading situations without indicating any luxation tendencies. This also provides initial benchtop evidence that the device offers suitable stability and kinematic behaviour to be considered a potential alternative to meniscus allograft transplantation in combination with an MOWHTO, potentially expanding the patient collective in the future.
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Affiliation(s)
- Matthias Sukopp
- grid.6582.90000 0004 1936 9748Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University, Medical Center, Helmholtzstrasse 14, 89081 Ulm, Germany
| | - Maoz Shemesh
- grid.508891.d0000 0004 0628 7030Active Implants LLC, 6060 Primacy Parkway, Suite 460, Memphis, TN USA
| | - Elena Pruech
- grid.508891.d0000 0004 0628 7030Active Implants LLC, 6060 Primacy Parkway, Suite 460, Memphis, TN USA
| | - Eran Linder-Ganz
- grid.508891.d0000 0004 0628 7030Active Implants LLC, 6060 Primacy Parkway, Suite 460, Memphis, TN USA
| | - Scott Hacker
- Grossmont Orthopedic Medical Group, 5565 Grossmont Center Drive, Building 3, Suite 256, La Mesa, CA USA
| | - Vincenzo Condello
- grid.500617.5Humanitas Castelli Clinic, Via Mazzini, 11, Bergamo, Italy
| | - Jonas Schwer
- grid.6582.90000 0004 1936 9748Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University, Medical Center, Helmholtzstrasse 14, 89081 Ulm, Germany
| | - Anita Ignatius
- grid.6582.90000 0004 1936 9748Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University, Medical Center, Helmholtzstrasse 14, 89081 Ulm, Germany
| | - Lutz Dürselen
- grid.6582.90000 0004 1936 9748Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University, Medical Center, Helmholtzstrasse 14, 89081 Ulm, Germany
| | - Andreas Martin Seitz
- Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University, Medical Center, Helmholtzstrasse 14, 89081, Ulm, Germany.
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Nguyen HC, van Egmond N, de Visser HM, Weinans H, Sakkers RJ, Custers RJ. Visual Inspection for Lower Limb Malalignment Diagnosis Is Unreliable. Cartilage 2022; 13:59-65. [PMID: 36305650 PMCID: PMC9924985 DOI: 10.1177/19476035221113952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Visual inspection of the lower limb is often part of standard clinical practice during a physical examination at the outpatient clinic. This study aims to investigate how reliable visual inspections are in terms of detecting lower limb malalignments without additional tools and physical examinations. DESIGN This study enrolled 50 patients. Each patient underwent a whole leg radiograph (WLR); in addition, a standardized digital photograph was taken of the lower limbs. Four persons (different experience levels) visually rated the digital photograph twice (unaware of the hip knee angle [HKA] on the WLR) and placed them in the category: severe valgus (>5°); moderate valgus (2°-5°); neutral, moderate varus (2°-5°); and severe varus (>5°). Visual ratings were compared with the measured HKA on WLRs for correlation using Spearman's rho. Linear ordinal regression models with significance when P < 0.05 were used to test whether body mass index (BMI), age, gender, and HKA were possible risk factors for incorrect visual HKA assessment. RESULTS Spearman's rho between the visual assessment and measured HKA on the WLR was moderate with 0.478 (P < 0.01). Women had an increased odds ratio of 3.7 (P = 0.001) for incorrect visual assessment. Higher HKA also increased the odds ratio for erroneous visual assessment with 1.4 (P = 0.003). BMI and age did not significantly increase the odds of erroneous visual leg axis assessments in this study. CONCLUSIONS Visual assessment of the lower limb alignment does not provide clinically relevant information. Lower limb malalignment diagnoses cannot be performed using only a visual inspection. Physical examination tests and radiographical assessments are advised. LEVEL OF EVIDENCE Diagnostic level II.
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Affiliation(s)
- H. Chien Nguyen
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Nienke van Egmond
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Huub M. de Visser
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Ralph J.B. Sakkers
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel J.H. Custers
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands,Roel J.H. Custers, Department of
Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584CX
Utrecht, The Netherlands.
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Bayram E, Şener N, Korkmaz M, Yıldırım C, Aydın M, Yurdaışık I, Çetinus ME. Internal tibial torsion is associated with medial meniscus posterior horn tears. Knee Surg Sports Traumatol Arthrosc 2022; 31:2251-2256. [PMID: 36153779 DOI: 10.1007/s00167-022-07173-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/15/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Risk factors for meniscal tears play a decisive role in deciding on treatment and rehabilitation. The purpose of this study was to investigate the effect of tibial rotation on medial meniscus posterior horn tears (MMPHTs). METHODS This study is a retrospective case-control study. Fifty patients with meniscal tears and 57 knees with intact meniscus were compared. Tibial rotation, femoral version, tibial slope and knee varus were measured in each participant. Knee osteoarthritis was classified according to the Kellgren-Lawrence classification. Demographic characteristics were noted. RESULTS There were significant differences in the mean tibial torsion angles and mean mechanical axes between the groups. The mean tibial rotation and mean mechanical axis were 26.3° ± 6.7 and 3.7° ± 2.7 in the MMPHT group and 30.3° ± 8.4 and 2.05° ± 2.7 in the control group, respectively (p = 0.008, p = 0.002). CONCLUSION The current retrospective study has shown that tibial rotation is markedly reduced in patients with MMPHTs. Although the actual mechanism is not clear, the internal torsion of the tibia causes a decrease in the foot progression angle and increases the knee adduction moment, which in turn increases the medial tibial contact pressure. Internal torsion of the tibia, such as knee varus, may play a role in the aetiology of MMPHTs by this way. Whilst there was a significant difference in the mean varus and tibial torsion between the groups, there was no significant difference in the mean femoral version or tibial slope. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Erhan Bayram
- Department of Orthopedics and Traumatology, Gaziosmapanasa Medicalpark Hospital, Istinye University, Merkez Mah., Çukurçeşme Sok. No: 57-59, Gaziosmanpaşa Medicalpark Hospital, Bayrampaşa, Istanbul, Turkey.
| | - Nurullah Şener
- Department of Orthopedics and Traumatology, Gaziosmapanasa Medicalpark Hospital, Istinye University, Merkez Mah., Çukurçeşme Sok. No: 57-59, Gaziosmanpaşa Medicalpark Hospital, Bayrampaşa, Istanbul, Turkey
| | - Musa Korkmaz
- Department of Orthopedics and Traumatology, Gaziosmapanasa Medicalpark Hospital, Istinye University, Merkez Mah., Çukurçeşme Sok. No: 57-59, Gaziosmanpaşa Medicalpark Hospital, Bayrampaşa, Istanbul, Turkey
| | - Cem Yıldırım
- Department of Orthopedics and Traumatology, Çam Ve Sakura Training and Research Hospital, Istanbul, Turkey
| | - Mahmud Aydın
- Department of Orthopedics and Traumatology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Işıl Yurdaışık
- Department of Radiology, Gaziosmapanasa Medicalpark Hospital, Istinye University, Istanbul, Turkey
| | - Mahmut Ercan Çetinus
- Department of Orthopedics and Traumatology, Gaziosmapanasa Medicalpark Hospital, Istinye University, Merkez Mah., Çukurçeşme Sok. No: 57-59, Gaziosmanpaşa Medicalpark Hospital, Bayrampaşa, Istanbul, Turkey
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Huddleston HP, Polce EM, Gilat R, Mehta N, Alzein M, Dandu N, Parvaresh KC, Cole BJ, Yanke AB. Time to Achieving Clinically Significant Outcomes After Meniscal Allograft Transplantation. Cartilage 2022; 13:19476035221102568. [PMID: 35864782 PMCID: PMC9310214 DOI: 10.1177/19476035221102568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To determine the time to achieving minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for commonly administered patient-reported outcome (PRO) measures and risk factors affecting achievement of clinically significant outcomes in patients undergoing meniscal allograft transplantation (MAT). METHODS A prospectively maintained MAT registry was retrospectively reviewed from April 2014 to May 2019. Patients who underwent revision MAT or did not complete preoperative PROs or one post operative time point were excluded. Patients who underwent concomitant procedures were included in the analysis. PROs were administered preoperatively and at 6 months, 1 year, and 2 years postoperatively. Previously defined MCID and PASS thresholds were utilized and Kaplan-Meier survival curve analysis with interval censoring was used to calculate the cumulative percentages of MCID and PASS achievement at each follow-up time interval (5-7, 11-13, and 23-25 months). RESULTS Eighty patients (age: 28.35 ± 9.76, 50% male) who completed preoperative, 6-month (n = 69, 86% compliance), and 1-year (n = 76, 95% compliance) PROs were included. The majority of patients (>50%) achieved MCID and PASS on most included PROs. Workers' compensation status was found to significantly delay achievement of MCID and PASS on all PROs except for PASS on Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life (QoL). Higher body mass index (BMI) significantly delayed time to achieving MCID on KOOS Pain and activities of daily living (ADL), as well as PASS on KOOS Symptoms and KOOS QoL. CONCLUSION This study suggests that the majority of patients have clinically significant improvements in pain and function after MAT, with more than 50% of patients experiencing clinically significant improvement within the first postoperative year. Workers' compensation status and high BMI may prolong time to achievement of MCID and PASS after MAT.
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Affiliation(s)
| | | | - Ron Gilat
- Rush University Medical Center, Chicago, IL, USA
| | - Nabil Mehta
- Rush University Medical Center, Chicago, IL, USA
| | | | - Navya Dandu
- Rush University Medical Center, Chicago, IL, USA
| | | | | | - Adam B. Yanke
- Rush University Medical Center, Chicago, IL, USA,Adam B. Yanke, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL 60612, USA.
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Kohno Y, Koga H, Ozeki N, Matsuda J, Mizuno M, Katano H, Sekiya I. Biomechanical analysis of a centralization procedure for extruded lateral meniscus after meniscectomy in porcine knee joints. J Orthop Res 2022; 40:1097-1103. [PMID: 34314533 PMCID: PMC9292650 DOI: 10.1002/jor.25146] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 06/02/2021] [Accepted: 07/13/2021] [Indexed: 02/04/2023]
Abstract
The recently developed arthroscopic centralization for lateral meniscal extrusion has obtained satisfactory short-term clinical and radiological results and improves the meniscus biomechanical properties. However, the effectiveness of treatment for meniscus extrusion after partial meniscectomy still requires elucidation. This study investigated the effect of centralization with modifications from a mechanical viewpoint. Porcine knee joints (N = 6) were set in a universal tester under the following conditions: (1) Intact; (2) Meniscectomy: Inner half of the posterior half meniscus was removed; (3) Extrusion: Posterior meniscus was dislocated laterally by transecting the posterior root and the meniscotibial ligament; (4) Centralization-1: Centralization procedure using one anchor; (5) Centralization-2: Centralization procedure using two anchors; and (6) Centralization-ad: Centralization with capsular advancement using two anchors. Load distributions and contact pressure in the meniscus and tibial cartilage were evaluated with an axial compressive force of 200 N. After meniscectomy, the tibial cartilage load increased and that of the medial margin of the posterior part of the meniscus decreased. When the meniscus was extruded, the load was concentrated only on the tibial cartilage. Centralization-1 increased the load on the meniscus, while Centralization-2 further increased the meniscus load but decreased the tibial cartilage load. Centralization-ad further decreased the load on the tibial plateau. The average contact pressure of the tibial cartilage was significantly higher in the Extrusion group than in the Intact group or the Centralization-ad group. From a biomechanical viewpoint, centralization with capsular advancement was the most effective of the tested procedures for treatment for an extruded meniscus after partial meniscectomy.
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Affiliation(s)
- Yuji Kohno
- Center for Stem Cells and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Nobutake Ozeki
- Center for Stem Cells and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Junpei Matsuda
- Center for Stem Cells and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Mitsuru Mizuno
- Center for Stem Cells and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Hisako Katano
- Center for Stem Cells and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Ichiro Sekiya
- Center for Stem Cells and Regenerative MedicineTokyo Medical and Dental UniversityTokyoJapan
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Nakagawa Y, Ozeki N, Koga H. A narrative review of lateral meniscus root tears and extrusion: techniques and outcomes. ANNALS OF JOINT 2022; 7:15. [PMID: 38529138 PMCID: PMC10929309 DOI: 10.21037/aoj-20-112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 04/23/2021] [Indexed: 03/27/2024]
Abstract
Objective In this review, we performed a literature search and described the surgical procedure for a lateral meniscus posterior root tears (LMPRT) repair using a pull-out technique and an arthroscopic centralization for lateral meniscus (LM) extrusion. Background The menisci play a pivotal role in the shock-absorbing and load-dispersing functions of the knee joint. They also contribute to its stability. Meniscal root tears substantially affect meniscal hoop function and accelerate cartilage degeneration. Additionally, LMPRT have been shown to affect anterolateral knee laxity and tibiofemoral contact pressure in knees with anterior cruciate ligament (ACL) injury. Therefore, appropriate management of LMPRT is essential for restoring knee function. Meniscus extrusion has attracted attention due to its association with early osteoarthritis (OA). Recently, an arthroscopic centralization technique has been proposed to reduce meniscal extrusion. During this procedure the capsule attached to the meniscus is sutured to the edge of the tibial plateau using suture anchors. Methods A narrative review of LMPRT repair and arthroscopic centralization of lateral meniscal extrusion was performed through a PubMed search. Conclusions Specific magnetic resonance imaging (MRI) signs were useful for the diagnosis of LMPRT. Pull-out techniques can restore knee stability and load distribution function and result in favorable clinical outcomes. Arthroscopic centralization of the extruded LM caused by meniscectomy and lateral discoid meniscus achieved satisfactory clinical outcomes at the 2-year follow-up. Biomechanical studies demonstrated that this procedure reduced meniscus extrusion and had beneficial effects on load distribution and joint stability. In summary, to restore knee function, LMPRT should be repaired as much as possible. The centralization technique is a promising surgical treatment for extruded lateral menisci due to meniscectomy and discoid meniscus. However, due to the lack of high-level evidence studies such as randomized control trials (RCTs) in this field, it remains necessary to accumulate evidence to confirm the efficacy of LMPRT repair and the centralization technique.
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Affiliation(s)
- Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Nobutake Ozeki
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
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Sukopp M, Schall F, Hacker SP, Ignatius A, Dürselen L, Seitz AM. Influence of Menisci on Tibiofemoral Contact Mechanics in Human Knees: A Systematic Review. Front Bioeng Biotechnol 2021; 9:765596. [PMID: 34926419 PMCID: PMC8681859 DOI: 10.3389/fbioe.2021.765596] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Menisci transfer axial loads, while increasing the load-bearing tibiofemoral contact area and decreasing tibiofemoral contact pressure (CP). Numerous clinical and experimental studies agree that an increased CP is one predominant indicator for post-traumatic osteoarthritis (PTOA) of the knee joint. However, due to the immense variability in experimental test setups and wide range of treatment possibilities in meniscus surgery, it is difficult to objectively assess their impact on the CP determination, which is clearly crucial for knee joint health. Therefore, the aim of this systematic review is to investigate the influence of different meniscal injuries and their associated surgical treatments on the CP. Secondly, the influence of different test setups on CP measurements is assessed. On the basis of these results, we established the basis for recommendations for future investigations with the aim to determine CPs under different meniscal states. Methods: This review was conducted in accordance with the PRISMA guidelines. Studies were identified through a systematic literature search in Cochrane, PubMed and Web of Science databases. Literature was searched through pre-defined keywords and medical subject headings. Results: This review indicates a significant increase of up to 235% in peak CP when comparing healthy joints and intact menisci with impaired knee joints, injured or resected menisci. In addition, different test setups were indicated to have major influences on CP: The variety of test setups ranged from standard material testing machines, including customized setups via horizontal and vertical knee joint simulators, through to robotic systems. Differences in applied axial knee joint loads ranged from 0 N up to 2,700 N and resulted unsurprisingly in significantly different peak CPs of between 0.1 and 12.06 MPa. Conclusion: It was shown that untreated traumatic meniscal tears result in an increased CP. Surgical repair intervention were able to restore the CP comparable to the healthy, native condition. Test setup differences and particularly axial joint loading variability also led to major CP differences. In conclusion, when focusing on CP measurements in the knee joint, transparent and traceable in vitro testing conditions are essential to allow researchers to make a direct comparison between future biomechanical investigations.
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Affiliation(s)
- Matthias Sukopp
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Florian Schall
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Steffen P Hacker
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Andreas M Seitz
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
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Asayama A, Tateuchi H, Yamagata M, Ichihashi N. Influence of stance width and toe direction on medial knee contact force during bodyweight squats. J Biomech 2021; 129:110824. [PMID: 34717162 DOI: 10.1016/j.jbiomech.2021.110824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
Squats are frequently performed to strengthen the quadriceps (Quad) and gluteus maximus (GM) in sports and clinical fields. Since the squat itself produces a large knee contact force, clarifying the relationship between the squat techniques and the knee contact force is important. However, the influence of different squat techniques on the medial knee contact force (KCFmed), which would result in knee disease, remains unclear. This study aimed to investigate the influence of various squat techniques on KCFmed during bodyweight squats. Since muscle strengthening by the squat is inevitable, we additionally aimed to explore the effect of a different squat technique on the quadriceps (Quad) and gluteus maximus (GM) forces. Twelve healthy adults performed squats with different stance widths (narrow stance, NS; middle stance, MS; and wide stance, WS) and different toe directions (0° of forefoot abduction - NEUT and 30°forefoot abduction - OUT). The KCFmed, Quad force, and GM force were computed using a musculoskeletal model with marker trajectories and ground reaction forces. The KCFmed in NS was significantly larger than that in MS and WS, and KCFmed in OUT was significantly larger than that in NEUT. The Quad force in OUT was significantly larger than that in the NEUT, and the GM force significantly became larger as the stance width became narrower. These findings suggest that squats in MS and NEUT may be suitable for reducing KCFmed while maintaining the Quad and GM forces.
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Affiliation(s)
- Akihiro Asayama
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan.
| | - Hiroshige Tateuchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Momoko Yamagata
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan; Department of Human Development, Graduate School of Human Development and Environment, Kobe University, Japan; Research Fellow of Japan Society for the Promotion of Science Kojimachi Business Center Building, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
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11
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Wang D, Willinger L, Athwal KK, Williams A, Amis AA. Knee Joint Line Obliquity Causes Tibiofemoral Subluxation That Alters Contact Areas and Meniscal Loading. Am J Sports Med 2021; 49:2351-2360. [PMID: 34125619 PMCID: PMC8283183 DOI: 10.1177/03635465211020478] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little scientific evidence is available regarding the effect of knee joint line obliquity (JLO) before and after coronal realignment osteotomy. HYPOTHESES Higher JLO would lead to abnormal relative position of the femur on the tibia, a shift of the joint contact areas, and elevated joint contact pressures. STUDY DESIGN Descriptive laboratory study. METHODS 10 fresh-frozen human cadaveric knees (age, 59 ± 5 years) were axially loaded to 1500 N in a materials testing machine with the joint line tilted 0°, 4°, 8°, and 12° varus ("downhill" medially) and valgus, at 0° and 20° of knee flexion. The mechanical compression axis was aligned to the center of the tibial plateau. Contact pressure and contact area were recorded by pressure sensors inserted between the tibia and femur below the menisci. Changes in relative femoral and tibial position in the coronal plane were obtained by an optical tracking system. RESULTS Both medial and lateral JLO caused significant tibiofemoral subluxation and pressure distribution changes. Medial (varus) JLO caused the femur to subluxate medially down the coronal slope of the tibial plateau, and vice versa for lateral (valgus) downslopes (P < .01), giving a 6-mm range of subluxation. The areas of peak pressure moved 12 mm and 8 mm across the medial and lateral condyles, onto the downhill meniscus and the "uphill" tibial spine. Changes in JLO had only small effects on maximum contact pressures. CONCLUSION A 4° change of JLO during load bearing caused significant mediolateral tibiofemoral subluxation. The femur slid down the slope of the tibial plateau to abut the tibial eminence and also to rest on the downhill meniscus. This caused large movements of the tibiofemoral contact pressures across each compartment. CLINICAL RELEVANCE These results provide important information for understanding the consequences of creating coronal JLO and for clinical practice in terms of osteotomy planning regarding the effect on JLO. This information provides guidance regarding the choice of single- or double-level osteotomy. Excessive JLO alteration may cause abnormal tibiofemoral joint articulation and chondral or meniscal loading.
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Affiliation(s)
- Dong Wang
- The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK,College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Lukas Willinger
- The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - Kiron K. Athwal
- The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | | | - Andrew A. Amis
- The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK,Address correspondence to Andrew A. Amis, FREng, DSc(Eng), The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ, UK ()
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12
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Seitz AM, Osthaus F, Schwer J, Warnecke D, Faschingbauer M, Sgroi M, Ignatius A, Dürselen L. Osteoarthritis-Related Degeneration Alters the Biomechanical Properties of Human Menisci Before the Articular Cartilage. Front Bioeng Biotechnol 2021; 9:659989. [PMID: 34026741 PMCID: PMC8134692 DOI: 10.3389/fbioe.2021.659989] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022] Open
Abstract
An exact understanding of the interplay between the articulating tissues of the knee joint in relation to the osteoarthritis (OA)-related degeneration process is of considerable interest. Therefore, the aim of the present study was to characterize the biomechanical properties of mildly and severely degenerated human knee joints, including their menisci and tibial and femoral articular cartilage (AC) surfaces. A spatial biomechanical mapping of the articulating knee joint surfaces of 12 mildly and 12 severely degenerated human cadaveric knee joints was assessed using a multiaxial mechanical testing machine. To do so, indentation stress relaxation tests were combined with thickness and water content measurements at the lateral and medial menisci and the AC of the tibial plateau and femoral condyles to calculate the instantaneous modulus (IM), relaxation modulus, relaxation percentage, maximum applied force during the indentation, and the water content. With progressing joint degeneration, we found an increase in the lateral and the medial meniscal instantaneous moduli (p < 0.02), relaxation moduli (p < 0.01), and maximum applied forces (p < 0.01), while for the underlying tibial AC, the IM (p = 0.01) and maximum applied force (p < 0.01) decreased only at the medial compartment. Degeneration had no influence on the relaxation percentage of the soft tissues. While the water content of the menisci did not change with progressing degeneration, the severely degenerated tibial AC contained more water (p < 0.04) compared to the mildly degenerated tibial cartilage. The results of this study indicate that degeneration-related (bio-)mechanical changes seem likely to be first detectable in the menisci before the articular knee joint cartilage is affected. Should these findings be further reinforced by structural and imaging analyses, the treatment and diagnostic paradigms of OA might be modified, focusing on the early detection of meniscal degeneration and its respective treatment, with the final aim to delay osteoarthritis onset.
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Affiliation(s)
- Andreas M Seitz
- Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Felix Osthaus
- Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Jonas Schwer
- Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Daniela Warnecke
- Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Martin Faschingbauer
- Department of Orthopedic Surgery, Universitäts- und Rehabilitationskliniken Ulm (RKU), Ulm University Medical Center, Ulm, Germany
| | - Mirco Sgroi
- Department of Orthopedic Surgery, Universitäts- und Rehabilitationskliniken Ulm (RKU), Ulm University Medical Center, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
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13
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Ren F, Huang J, Chen X, Wu J, Zhao Q. Medial Meniscus Posterior Root Tear Treatment: Letter to the Editor. Am J Sports Med 2021; 49:NP6-NP7. [PMID: 33523754 DOI: 10.1177/0363546520979962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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14
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Winkler PW, Rothrauff BB, Buerba RA, Shah N, Zaffagnini S, Alexander P, Musahl V. Meniscal substitution, a developing and long-awaited demand. J Exp Orthop 2020; 7:55. [PMID: 32712722 PMCID: PMC7382673 DOI: 10.1186/s40634-020-00270-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023] Open
Abstract
The menisci represent indispensable intraarticular components of a well-functioning knee joint. Sports activities, traumatic incidents, or simply degenerative conditions can cause meniscal injuries, which often require surgical intervention. Efforts in biomechanical and clinical research have led to the recommendation of a meniscus-preserving rather than a meniscus-resecting treatment approach. Nevertheless, partial or even total meniscal resection is sometimes inevitable. In such circumstances, techniques of meniscal substitution are required. Autologous, allogenic, and artificial meniscal substitutes are available which have evolved in recent years. Basic anatomical and biomechanical knowledge, clinical application, radiological and clinical outcomes as well as future perspectives of meniscal substitutes are presented in this article. A comprehensive knowledge of the different approaches to meniscal substitution is required in order to integrate these evolving techniques in daily clinical practice to prevent the devastating effects of lost meniscal tissue.
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Affiliation(s)
- Philipp W Winkler
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.,Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.,Center for Cellular and Molecular Engineering, University of Pittsburgh, 450 Technology Drive, Suite 239, Pittsburgh, PA, 15219, USA
| | - Rafael A Buerba
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| | - Neha Shah
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| | - Stefano Zaffagnini
- 2° Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, IRCCS, University of Bologna, Bologna, Italy
| | - Peter Alexander
- Center for Cellular and Molecular Engineering, University of Pittsburgh, 450 Technology Drive, Suite 239, Pittsburgh, PA, 15219, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.
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15
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Kubota R, Koga H, Ozeki N, Matsuda J, Kohno Y, Mizuno M, Katano H, Sekiya I. The effect of a centralization procedure for extruded lateral meniscus on load distribution in porcine knee joints at different flexion angles. BMC Musculoskelet Disord 2020; 21:205. [PMID: 32245447 PMCID: PMC7126455 DOI: 10.1186/s12891-020-03197-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/09/2020] [Indexed: 12/25/2022] Open
Abstract
Background Meniscal extrusion results in loss of the ability to resist hoop strain and biomechanical overload on the joint articular surface. A centralization technique has been developed to overcome these problems. In this study, we analyzed the biomechanics of the extruded and centralized lateral meniscus (LM) in porcine knee joints at different flexion angles. Methods Porcine knee joints (n = 8) were set in the universal tester and each knee was tested under the following states: 1) intact; 2) extrusion—meniscal extrusion was created by resecting the posterior root of the LM and posterior synovial capsule; and 3) centralization—centralization was performed by two anchors inserted in the lateral tibial plateau. Deviation distance of the meniscus, contact pressure, and contact area in the anterior LM, middle LM, posterior LM, and the contact pressure of the tibial cartilage were evaluated with an axial compressive force of 200 N at knee flexion angles of 30°, 45°, 60°, and 90°. Results The deviation distance of LM significantly increased in extrusion but was restored to the intact status after centralization at all angles. Both the contact pressure and area significantly decreased in extrusion and were restored after centralization close to the intact status in the anterior and middle LM; in the posterior LM, however, decreased contact pressure and area were not restored after centralization. The contact pressure of the tibial cartilage increased significantly in extrusion but decreased close to the intact status after centralization. Conclusions This centralization procedure could reduce extrusion of the LM and restore the load-distributing function of the anterior-middle LM. However, the procedure itself could not restore hoop function in cases where the defect lies in the posterior LM.
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Affiliation(s)
- Rei Kubota
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Bunkyo City, Japan
| | - Nobutake Ozeki
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Junpei Matsuda
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yuji Kohno
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Mitsuru Mizuno
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hisako Katano
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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16
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Varus alignment increases medial meniscus extrusion and peak contact pressure: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 2020; 28:1092-1098. [PMID: 31489460 DOI: 10.1007/s00167-019-05701-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/28/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Assessment of medial meniscus extrusion (MME) has become increasingly popular in clinical practice to evaluate the dynamic meniscus function and diagnose meniscus pathologies. The purpose of this biomechanical study was to investigate the correlation between MME and the changes in joint contact pressure in varus and valgus alignment. It was hypothesized that varus alignment would result in significantly higher MME along with a higher joint contact pressure in the medial compartment. METHODS Eight fresh-frozen human cadaveric knees were axially loaded, with a 750 N compressive load, in full extension with the mechanical axis shifted to intersect the tibial plateau at 30% and 40% (varus), 50% (neutral), 60% and 70% (valgus) of its width (TPW). Tibiofemoral peak contact pressure (PCP), mean contact pressure (MCP) and contact area (CA) were determined using pressure-sensitive films. MME was obtained via ultrasound at maximum load. RESULTS MME was significantly increased from valgus (1.32 ± 0.22 mm) to varus alignment (3.16 ± 0.24 mm; p < 0.001). Peak contact pressure at 30% TPW varus alignment was significantly higher compared to 60% TPW valgus (p = 0.018) and 70% TPW valgus (p < 0.01). MME significantly correlated with PCP (r = 0.56; p < 0.001) and MCP (r = 0.47, p < 0.01) but not with CA (r = 0.23; n.s.). CONCLUSION MME was significantly increased in varus alignment, compared to neutral or valgus alignment, with an intact medial meniscus. It was also significantly correlated with PCP and MCP within the medial compartment. However, valgus malalignment and neutral axis resulted in reduced MME and contact pressure. Lower limb alignment must be taken into account while assessing MME in clinical practice. LEVEL OF EVIDENCE Controlled laboratory study.
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17
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Willinger L, Lang JJ, Berthold D, Muench LN, Achtnich A, Forkel P, Imhoff AB, Burgkart R, von Deimling C. Varus alignment aggravates tibiofemoral contact pressure rise after sequential medial meniscus resection. Knee Surg Sports Traumatol Arthrosc 2020; 28:1055-1063. [PMID: 31377827 DOI: 10.1007/s00167-019-05654-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/26/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Arthroscopic partial meniscectomy of medial meniscus tears and varus alignment are considered independent risk factors for increased medial compartment load, thus contributing to the development of medial osteoarthritis. The purpose of this biomechanical study was to investigate the effect of lower limb alignment on contact pressure and contact area in the knee joint following sequential medial meniscus resection. It was hypothesized that a meniscal resection of 50% would lead to a significant overload of the medial compartment in varus alignment. METHODS Eight fresh-frozen human cadaveric knees were axially loaded with a 750 N compressive force in full extension with the mechanical axis rotated to intersect the tibia plateau at 30%, 40%, 50%, 60% and 70% of its width. Tibiofemoral mean contact pressure (MCP), peak contact pressure (PCP), and contact area (CA) of the medial and lateral compartment were measured separately using pressure-sensitive films (K-Scan 4000, Tekscan) in four different meniscal conditions, respectively, intact, 50% resection, 75% resection, and total meniscectomy. RESULTS Medial MCP was significantly increased when comparing the intact meniscus to each meniscal resection in all tested alignments (p < 0.05). Following meniscal resection of 50%, MCP was significantly higher with greater varus alignment compared to valgus alignment (p < 0.05). Similarly, medial PCP was higher at varus alignment compared to valgus alignment (p < 0.05). Further resection to 75% and 100% of the meniscus resulted in a significantly higher medial PCP at 30% of tibia plateau width compared to all other alignments (p < 0.05). Medial CA of the intact meniscus decreased significantly after 50%, 75% and 100% meniscal resection in all alignments (p < 0.05). Lateral joint pressure was not significantly increased by greater valgus alignment. CONCLUSION Lower limb alignment and the extent of medial meniscal resection significantly affect tibiofemoral contact pressure. Combined varus alignment and medial meniscal resection increased MCP and PCP within the medial compartment, whereas valgus alignment prevented medial overload. As a clinical consequence, lower limb alignment should be considered in the treatment of patients undergoing arthroscopic partial meniscectomy with concomitant varus alignment. In patients presenting with ongoing medial joint tenderness and effusion, realignment osteotomy can be a surgical technique to unload the medial compartment.
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Affiliation(s)
- Lukas Willinger
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Hospital Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Jan J Lang
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Hospital Rechts der Isar, Munich, Germany.,Department of Trauma Surgery, Technical University of Munich, Hospital Rechts der Isar, Munich, Germany.,Chair of Non-destructive Testing, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany
| | - Daniel Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Hospital Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Hospital Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andrea Achtnich
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Hospital Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Philipp Forkel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Hospital Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Hospital Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rainer Burgkart
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Hospital Rechts der Isar, Munich, Germany
| | - Constantin von Deimling
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Hospital Rechts der Isar, Munich, Germany.,Chair of Applied Mechanics, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany
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18
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Willinger L, Lang JJ, Berthold D, Muench LN, Achtnich A, Forkel P, Imhoff AB, Burgkart R, von Deimling C. Die Beinachse beeinflusst die Druckveränderung im medialen Kompartiment des Kniegelenks nach Meniskusteilresektion. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Articular Comorbidities in Revision Cartilage Surgery: Meniscal Allograft Transplantation and Realignment. OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2019.150709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Fang CH, Liu H, Di ZL, Zhang JH. Arthroscopic all-inside repair with suture hook for horizontal tear of the lateral meniscus at the popliteal hiatus region: a preliminary report. BMC Musculoskelet Disord 2020; 21:52. [PMID: 31996263 PMCID: PMC6990581 DOI: 10.1186/s12891-020-3066-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/14/2020] [Indexed: 12/03/2022] Open
Abstract
Background Arthroscopic surgery procedures vary depending on the types of meniscus tear, including meniscectomy and meniscus repair. Among the several types of meniscus tear, the horizontal tear of the lateral meniscus at the popliteal hiatus region is a common injury, and its surgical treatment is still inconsistent. Methods Between January 2018 and October 2018, 20 patients who underwent all-inside repair with suture hook for the horizontal tear of the lateral meniscus at the popliteal hiatus region were recruited. Any operative complication was recorded, and postoperative MRI scans were conducted at the 6 months. The clinical results were graded based on the scale of the Lysholm knee score preoperatively and at follow-up. Results No operative complications were recorded. Postoperative MRIs at the 6 months showed that there was no re-tear for all patients, though signal intensity remained high in T2-weighted MRI in the lateral meniscus for nine cases. The average preoperative Lysholm knee score was 58.6 ± 10.1, which increased significantly to 89.3 ± 7.8 (t = − 11.01, p = 0.001) at the last follow-up. Recurrence or aggravation of symptoms was not noted at the final follow-up. Conclusion All-inside repair with suture hook may be a good option for the horizontal tear of the lateral meniscus at the popliteal hiatus region which preserves the meniscus; avoids iatrogenic injury on the adjacent popliteal tendon, common peroneal nerve, and inferior lateral geniculate artery.
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Affiliation(s)
- Chao-Hua Fang
- Department of Joint Surgery, the 6th Hospital of Ningbo, No.1059 Zhongshan road, Yinzhou District, Ningbo, 315000, Zhejiang, People's Republic of China.,Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China
| | - Hua Liu
- Department of Joint Surgery, the 6th Hospital of Ningbo, No.1059 Zhongshan road, Yinzhou District, Ningbo, 315000, Zhejiang, People's Republic of China
| | - Zheng-Lin Di
- Department of Joint Surgery, the 6th Hospital of Ningbo, No.1059 Zhongshan road, Yinzhou District, Ningbo, 315000, Zhejiang, People's Republic of China
| | - Jun-Hui Zhang
- Department of Joint Surgery, the 6th Hospital of Ningbo, No.1059 Zhongshan road, Yinzhou District, Ningbo, 315000, Zhejiang, People's Republic of China.
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Bernard CD, Kennedy NI, Tagliero AJ, Camp CL, Saris DBF, Levy BA, Stuart MJ, Krych AJ. Medial Meniscus Posterior Root Tear Treatment: A Matched Cohort Comparison of Nonoperative Management, Partial Meniscectomy, and Repair. Am J Sports Med 2020; 48:128-132. [PMID: 31765234 DOI: 10.1177/0363546519888212] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are limited data comparing the outcomes of similarly matched patients with a medial meniscus posterior root tear (MMPRT) treated with nonoperative management, partial meniscectomy, or repair. PURPOSE/HYPOTHESIS The purpose was to compare treatment failure, clinical outcome scores, and radiographic findings for a matched cohort of patients who underwent either nonoperative management, partial meniscectomy, or transtibial pull-through repair for an MMPRT. We hypothesized that patients who underwent meniscus root repair will have lower rates of progression to arthroplasty than patients who were treated with nonoperative management or partial meniscectomy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent transtibial medial meniscus posterior horn root repair were matched by meniscal laterality, age, sex, and Kellgren-Lawrence (K-L) grades to patients treated nonoperatively or with a partial meniscectomy. Progression to arthroplasty rates, International Knee Documentation Committee and Tegner scores, and radiographic outcomes were analyzed between groups. RESULTS Forty-five patients were included in this study (15 nonoperative, 15 partial meniscectomy, 15 root repair). Progression to arthroplasty demonstrated significant differences among treatment groups at a mean of 74 months (nonoperative, 4/15; partial meniscectomy, 9/15; meniscal repair, 0/15; P = .0003). The meniscus root repair group had significantly less arthritic progression, as measured by change in K-L grade from pre- to postoperatively (nonoperative, 1.0; partial meniscectomy, 1.1; meniscal repair, 0.1; P = .001). CONCLUSION Meniscus root repair leads to significantly less arthritis progression and subsequent knee arthroplasty compared with nonoperative management and partial meniscectomy in a matched cohort based on patient characteristics.
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Affiliation(s)
| | - Nicholas I Kennedy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam J Tagliero
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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