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Medial meniscus grafting restores normal tibiofemoral contact pressures

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Tissue excision in the setting of a meniscal tear has been shown to dramatically increase peak contact stresses in the affected tibiofemoral joint compartment, leading to the development of degenerative changes and osteoarthritis.

Purpose/hypothesis

The current in vitro study utilized a porcine model to evaluate the effectiveness of segmental medial meniscal grafting following partial meniscectomy. The study hypothesis was that the procedure would normalize medial tibofemoral joint compartment pressure magnitudes, areas, and locations relative to an intact meniscus.

Study design

Controlled laboratory study.

Methods

Using pressure film, medial tibiofemoral joint compartment peak, and mean pressure magnitudes, peak pressure location and peak pressure area were determined using 12 potted, fresh frozen, porcine knee specimens. Data were collected at three different knee flexion angles (90°, 45°, and 0°) for three conditions: intact medial meniscus, following resection of the central third of the medial meniscus, and following segmental medial meniscal grafting. For each condition, the potted femur was positioned horizontally in a bench vise clamp, while a 20 pound (88.96 N) axial compression force was manually applied for a 60 s duration by the primary investigator through the base of the potted tibia using a digital force gauge.

Results

Loss of the central 1/3 of the medial meniscus resulted in significant increases in the mean and peak pressures of the medial tibiofemoral joint compartment and decreased peak pressure area. Segmental meniscal grafting of the central third defect closely recreated the contact pressures and loading areas of the native, intact medial meniscus.

Conclusion

From a static, time zero biomechanical perspective, segmental medial meniscus grafting of a partially meniscectomized knee restored mean pressure, peak pressure, and mean peak contact pressure areas of the medial tibiofemoral joint compartment back to levels observed in the intact medial meniscus at different knee flexion angles. In-vivo analysis under dynamic conditions is necessary to verify the healing efficacy and ability of the healed segmental medial meniscal allograft to provide long-term knee joint homeostasis when confronted with dynamic shear, rotatory, and combined, higher magnitude physiologic loading forces.

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References

  1. McNickle AG, Wang VM, Shewman EF, Cole BJ, Williams JM (2009) Performance of a sterile meniscal allograft in an ovine model. Clin Orthop Relat Res 467:1868–1876

    Article  PubMed  Google Scholar 

  2. Mora G, Alvarez E, Ripalda P, Forriol F (2003) Articular cartilage degeneration after frozen meniscus and Achilles tendon allograft transplantation: experimental study in sheep. Arthroscopy 19:833–841

    Article  PubMed  Google Scholar 

  3. Rongen JJ, Hannink G, van Tienen TG, van Luijk J, Hooijmans CR (2015) The protective effect of meniscus allograft transplantation on articular cartilage: a systematic review of animal studies. Osteoarthr Cartil 23:1242–1253

    Article  CAS  PubMed  Google Scholar 

  4. Smith NA, Parkinson B, Hutchinson CE, Costa ML, Spalding T (2015) Is meniscal allograft transplantation chondroprotective? A systematic review of radiological outcomes. Knee Surg Sports Traumatol Arthrosc 24:2923–2935

    Article  PubMed  Google Scholar 

  5. Baratz ME, Fu FH, Mengato R (1986) Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med 14:270–275

    Article  CAS  PubMed  Google Scholar 

  6. Beamer BS, Masoudi A, Walley KC et al (2015) Analysis of a new all-inside versus inside-out technique for repairing radial meniscal tears. Arthroscopy 31:293–298

    Article  PubMed  Google Scholar 

  7. Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Joint Surg Br 30:664–670

    Article  Google Scholar 

  8. Vaquero J, Forriol F (2016) Meniscus tear surgery and meniscus replacement. Muscles Ligaments Tendons J 6(1):71–89

    PubMed  PubMed Central  Google Scholar 

  9. Verdonk R, Madry H, Shabshin N et al (2016) The role of meniscal tissue in joint protection in early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24:1763–1774

    Article  PubMed  Google Scholar 

  10. Aagaard H, Jorgensen U, Bojsen-Moller F (1999) Reduced degenerative articular cartilage changes after meniscal allograft transplantation in sheep. Knee Surg Sports Traumatol Arthrosc 7:184–191

    Article  CAS  PubMed  Google Scholar 

  11. Brindle T, Nyland J, Johnson DL (2001) The meniscus: review of basic principles with application to surgery and rehabilitation. J Athl Train 36:160–169

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Choi NH, Kim TH, Son KM, Victoroff BN (2010) Meniscal repair for radial tears of the midbody of the lateral meniscus. Am J Sports Med 38:2472–2476

    Article  PubMed  Google Scholar 

  13. Song HS, Bae TY, Park BY, Shim J, In Y (2014) Repair of a radial tear in the posterior horn of the lateral meniscus. Knee 21:1185–1190

    Article  PubMed  Google Scholar 

  14. Lee SJ, Aadalen KJ, Malaviya P et al (2006) Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee. Am J Sports Med 34:1334–1344

    Article  PubMed  Google Scholar 

  15. Elattar M, Dhollander A, Verdonk R, Almqvist KF, Verdonk P (2011) Twenty-six years of meniscal allograft transplantation: is it still experimental? A meta-analysis of 44 trials. Knee Surg Sports Traumatol Arthrosc 19:147–157

    Article  PubMed  Google Scholar 

  16. Lee YH, Nyland J, Burden R, Caborn DN (2013) Repair of peripheral vertical meniscus lesions in porcine menisci: in vitro biomechanical testing of 3 different meniscus repair devices. Am J Sports Med 41:1074–1081

    Article  PubMed  Google Scholar 

  17. Salata MJ, Gibbs AE, Sekiya JK (2010) A systematic review of clinical outcomes in patients undergoing meniscectomy. Am J Sports Med 38:1907–1916

    Article  PubMed  Google Scholar 

  18. Arno S, Hadley S, Campbell KA et al (2013) The effect of arthroscopic partial medial meniscectomy on tibiofemoral stability. Am J Sports Med 41:73–79

    Article  PubMed  Google Scholar 

  19. Walker PS, Arno S, Bell C, Salvadore G, Borukhov I, Oh C (2015) Function of the medial meniscus in force transmission and stability. J Biomech 48:1383–1388

    Article  PubMed  Google Scholar 

  20. Verma NN, Kolb E, Cole BJ et al (2008) The effects of medial meniscal transplantation techniques on intra-articular contact pressures. J Knee Surg 21:20–26

    Article  PubMed  Google Scholar 

  21. Rosso F, Bisicchia S, Bonasia DE, Amendola A (2015) Meniscal allograft transplantation: a systematic review. Am J Sports Med 43:998–1007

    Article  PubMed  Google Scholar 

  22. Brophy RH, Matava MJ (2012) Surgical options for meniscal replacement. J Am Acad Orthop Surg 20:265–272

    Article  PubMed  Google Scholar 

  23. Bulgheroni E, Grassi A, Bulgheroni P, Marcheggiani Muccioli GM, Zaffagnini S, Marcacci M (2015) Long-term outcomes of medial CMI implant versus partial medial meniscectomy in patients with concomitant ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 23:3221–3227

    Article  PubMed  Google Scholar 

  24. Harston A, Nyland J, Brand E, McGinnis M, Caborn DN (2012) Collagen meniscus implantation: a systematic review including rehabilitation and return to sports activity. Knee Surg Sports Traumatol Arthrosc 20:135–146

    Article  PubMed  Google Scholar 

  25. Schuttler KF, Haberhauer F, Gesslein M et al (2016) Midterm follow-up after implantation of a polyurethane meniscal scaffold for segmental medial meniscus loss: maintenance of good clinical and MRI outcome. Knee Surg Sports Traumatol Arthrosc 24:1478–1484

    Article  PubMed  Google Scholar 

  26. Baynat C, Andro C, Vincent JP et al (2014) Actifit synthetic meniscal substitute: experience with 18 patients in Brest, France. Orthop Traumatol Surg Res 100(8 Suppl):S385–S389

    Article  CAS  PubMed  Google Scholar 

  27. Spencer SJ, Saithna A, Carmont MR, Dhillon MS, Thompson P, Spalding T (2012) Meniscal scaffolds: early experience and review of the literature. Knee 19:760–765

    Article  CAS  PubMed  Google Scholar 

  28. Arnoczky SP, Cook JL, Carter T, Turner AS (2010) Translational models for studying meniscal repair and replacement: what they can and cannot tell us. Tissue Eng Part B Rev 16:31–39

    Article  PubMed  Google Scholar 

  29. Majewski M, Stoll R, Muller W, Friederich NF (2009) Rotatory stability of the knee after arthroscopic repair: a 15-to-17 year follow-up study of isolated medial and lateral meniscus tears. Acta Orthop Belg 75:354–359

    PubMed  Google Scholar 

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Acknowledgements

This study was sponsored by the Joint Restoration Foundation™, 6278 South Troy Circle, Centennial, CO 80111. Thanks to David Wilke for his assistance.

Author information

Authors and Affiliations

  1. Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA

    John Nyland, Alaa Kalloub & David N. M. Caborn

  2. Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, 901 South 4th Street, Louisville, KY, 40203-2188, USA

    John Nyland & Katrina Kuban

  3. New York University Hospital for Joint Diseases, New York, NY, USA

    Kirk Campbell & Eric J. Strauss

  4. Shea Orthopedic Group, KentuckyOne Health, 201 Abraham Flexner Way, Louisville, KY, USA

    Alaa Kalloub & David N. M. Caborn

Authors
  1. John Nyland
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  2. Kirk Campbell
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  3. Alaa Kalloub
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  4. Eric J. Strauss
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  5. Katrina Kuban
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  6. David N. M. Caborn
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Corresponding author

Correspondence to John Nyland.

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Conflict of interest

The authors declare that they have no conflict of interest. Dr. DC and Dr. ES are consultants for the Joint Restoration Foundation.

Funding

This study was funded by a grant from the Joint Restoration Foundation, Centennial, Colorado, USA.

Ethical approval

This article does not contain any human participants. In vitro porcine specimens used for study purposes were obtained from a local abattoir.

Informed consent

Not applicable.

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Nyland, J., Campbell, K., Kalloub, A. et al. Medial meniscus grafting restores normal tibiofemoral contact pressures. Arch Orthop Trauma Surg 138, 361–367 (2018). https://doi.org/10.1007/s00402-017-2849-x

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  • DOI: https://doi.org/10.1007/s00402-017-2849-x

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