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Medial meniscal extrusion greater than 4 mm reduces medial tibiofemoral compartment contact area: a biomechanical analysis of tibiofemoral contact area and pressures with varying amounts of meniscal extrusion

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The primary objective of this study is to evaluate the contact areas, contact pressures, and peak pressures in the medial compartment of the knee in six sequential testing conditions. The secondary objective is to establish how much the medial meniscus is able to extrude, secondary to soft tissue injury while keeping its roots intact.

Methods

Ten cadaveric knees were dissected and tested in six conditions: (1) intact meniscus, (2) 2 mm extrusion, (3) 3 mm extrusion, (4) 4 mm extrusion, (5) maximum extrusion, (6) capsular based meniscal repair. Knees were loaded with a 1000-N axial compressive force at 0°, 30°, 60°, and 90° for each condition. Medial compartment contact area, average contact pressure, and peak contact pressure data were recorded.

Results

When compared to the intact state, there was no statistically significant difference in medial compartment contact area at 2 mm of extrusion or 3 mm of extrusion (n.s.). There was a statistically significant decrease in contact area compared to the intact state at 4 mm (p = 0.015) and maximum extrusion (p < 0.001). The repair state was able to improve medial compartment contact area, and there was no statistically significant difference between the repair and the intact states (n.s.). No significant differences were found in the average contact pressure between the repair, intact, or maximum extrusion conditions at any flexion angle (n.s.). No significant differences were found in the peak contact pressure between the repair, intact, or maximum extrusion conditions at any flexion angle (n.s.).

Conclusion

In this in vitro model, medial meniscus extrusion greater than 4 mm reduced medial compartment contact area, but meniscal extrusion did not significantly increase pressure in the medial compartment. Additionally, meniscal centralization was effective in restoring the medial tibiofemoral contact area to intact state when the meniscal extrusion was secondary to meniscotibial ligament injury. The diagnosis of meniscal extrusion may not necessarily involve meniscal root injury. Since it is known that meniscal extrusion greater than 3 or 4 mm has a biomechanical impact on tibiofemoral compartment contact area and pressures, specific treatments can be established. Centralization restored medial compartment contact area to the intact state.

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Funding

The University of Connecticut Health Center/UConn Musculoskeletal Institute has received direct funding and material support for this study from Arthrex.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil

    Pedro Debieux, João Victor Novaretti, Diego Costa Astur & Moises Cohen

  2. Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil

    Pedro Debieux, João Victor Novaretti, Camila Cohen Kaleka & Moises Cohen

  3. Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, 120 Dowling Way, Farmington, CT, 06030, USA

    Andrew E. Jimenez, Danielle E. Kriscenski, Elifho Obopilwe, Lisa M. Tamburini, Lukas N. Muench, Mark P. Cote & Katherine J. Coyner

  4. Av Pedroso de Morais, 2567, Sao Paulo, SP, 01259-010, Brazil

    Pedro Debieux

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  1. Pedro Debieux
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Contributions

PD: experimental testing of the cadavers, writing of paper and editing. AEJ: responsible for dissection and potting of the knee cadavers, participated in the experimental testing of the cadavers, responsible for statistical data analysis, editing and writing of paper. JVN: experimental testing of the cadavers, writing of paper and editing. CCK: experimental testing of the cadavers, writing of paper and editing. DEK: responsible for dissection and potting of the knee cadavers, participated in the pilot study of the experiment, participated in the experimental testing of the cadavers. DCA: experimental testing of the cadavers, writing of paper and editing. EO: responsible for the study design of the experiment, Tekscan calibrations and data collection during the experimental testing. LMT: responsible for dissection and potting of the knee cadavers, participated in the pilot study of the experiment, participated in the experimental testing of the cadavers. LNM: responsible for Tekscan data collection during the experimental testing and statistical data analysis. MPC: statistical analysis. MC: responsible for the study design of the experiment and supervised the experimental design. KJC: responsible for the study design of the experiment, managed the pilot study of the experiment, supervised the experimental design and testing of the cadavers.

Corresponding author

Correspondence to Andrew E. Jimenez.

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Conflict of interest

Arthrex donated human cadaver knee specimens and medical devices/supplies. P.D., C.C.K. and M.C are a consultant from Arthrex.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standard.

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Debieux, P., Jimenez, A.E., Novaretti, J.V. et al. Medial meniscal extrusion greater than 4 mm reduces medial tibiofemoral compartment contact area: a biomechanical analysis of tibiofemoral contact area and pressures with varying amounts of meniscal extrusion. Knee Surg Sports Traumatol Arthrosc 29, 3124–3132 (2021). https://doi.org/10.1007/s00167-020-06363-0

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