Abstract
Purpose
The major meniscal functions are load bearing, load distribution, and shock absorption by increasing the tibiofemoral joint (TFJ) contact area and dissipating axial loads by conversion into hoop stresses. The increased hoop strain stretches the meniscus in outward direction towards radius, causing extrusion, which is associated with the root tear and resultant degenerative osteoarthritis. Since the larger contact area of medial TFJ may increase the hoop stresses, we hypothesized that the larger medial femoral to tibial condylar dimension would contribute to the development of medial meniscus posterior root tear (MMPRT). Thus, the purpose of the study was to assess the relationship between MMPRT and medial femoral to tibial condylar dimension.
Methods
A case–control study was conducted to compare medial femoral to tibial condylar dimensions of patients with complete MMPRT (n = 59) with those of demography-matched controls (n = 59) during the period from 2010 to 2013. In each patient, MRIs were reviewed and several parameters were measured including articulation width of medial femoral condyle (MFC) at 0°, 30°, 60°, and 90°, medial tibial condyle (MTC) width, degree of meniscal extrusion, and medial femoral to tibial condylar width ratio (MFC/MTC) at 0°, 30°, 60°, and 90°, respectively. Demographic and radiographic data were assessed.
Results
A larger medial femoral to tibial condylar dimension was associated with MMPRT at 0° and 30° knee angles. Patients with MFC/MTC greater than 0.9 at 0° also showed about 2.5-fold increase in the chance of MMPRT. Those with meniscal extrusion greater than 3 mm also had about 17.1 times greater chance for the presence of MMPRT accordingly.
Conclusions
A larger medial femoral to tibial condylar dimension may be considered as one of the regional contributors to the outbreak of MMPRT, and medial femoral to tibial condylar width ratio greater than 0.9 at 0° knee angle may be considered as a significant risk factor for MMPRT.
Level of evidence
III.
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References
Ahmed AM, Burke DL (1983) In-vitro measurement of static pressure distribution in synovial joints—part I: tibial surface of the knee. J Biomech Eng 105:216–225
Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am 90:1922–1931
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
Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 42:3016–3030
Bin SI, Kim JM, Shin SJ (2004) Radial tears of the posterior horn of the medial meniscus. Arthroscopy 20:373–378
Boxheimer L, Lutz AM, Treiber K, Goepfert K, Crook DW, Marincek B, Weishaupt D (2004) MR imaging of the knee: position related changes of the menisci in asymptomatic volunteers. Invest Radiol 39:254–263
Bylski-Austrow DI, Ciarelli MJ, Kayner DC, Matthews LS, Goldstein SA (1994) Displacements of the menisci under joint load: an in vitro study in human knees. J Biomech 27:421–431
Choi NH, Son KM, Victoroff BN (2008) Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus: a technical note. Knee Surg Sports Traumatol Arthrosc 16:891–893
Chon JG, Kim JB, Lee BJ (2013) Magnetic resonance imaging usefulness after medial meniscus posterior root tear repair. J Korean Arthrosc Soc 17:6–10
Costa CR, Morrison WB, Carrino JA (2004) Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol 183:17–23
DeFrate LE, Sun H, Gill TJ, Rubash HE, Li G (2004) In vivo tibiofemoral contact analysis using 3D MRI-based knee models. J Biomech 37:1499–1504
Felson DT (2004) An update on the pathogenesis and epidemiology of osteoarthritis. Radiol Clin North Am 42:1–9
Fithian DC, Kelly MA, Mow VC (1990) Material properties and structure-function relationships in the menisci. Clin Orthop Relat Res 252:19–31
Fox AJ, Bedi A, Rodeo SA (2012) The basic science of human knee menisci: structure, composition, and function. Sports Health 4:340–351
Freutel M, Seitz AM, Galbusera F, Bornstedt A, Rasche V, Knothe Tate ML, Ignatius A, Durselen L (2014) Medial meniscal displacement and strain in three dimensions under compressive loads: MR assessment. J Magn Reson Imaging 40:1181–1188
Fukubayashi T, Kurosawa H (1980) The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthrotic knee joints. Acta Orthop Scand 51:871–879
Hein CN, Deperio JG, Ehrensberger MT, Marzo JM (2011) Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement. Knee 18:189–192
Hunter DJ (2011) Osteoarthritis. Best Pract Res Clin Rheumatol 25:801–814
Hwang BY, Kim SJ, Lee SW, Lee HE, Lee CK, Hunter DJ, Jung KA (2012) Risk factors for medial meniscus posterior root tear. Am J Sports Med 40:1606–1610
Jones AO, Houang MT, Low RS, Wood DG (2006) Medial meniscus posterior root attachment injury and degeneration: MRI findings. Australas Radiol 50:306–313
Jung YH, Choi NH, Oh JS, Victoroff BN (2012) All-inside repair for a root tear of the medial meniscus using a suture anchor. Am J Sports Med 40:1406–1411
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502
Kenny C (1997) Radial displacement of the medial meniscus and Fairbank’s signs. Clin Orthop Relat Res 339:163–173
Kim JG, Lee YS, Bae TS, Ha JK, Lee DH, Kim YJ, Ra HJ (2013) Tibiofemoral contact mechanics following posterior root of medial meniscus tear, repair, meniscectomy, and allograft transplantation. Knee Surg Sports Traumatol Arthrosc 21:2121–2125
Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ (2011) Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy 27:1644–1653
Kim JM, Jung SH, Lee SH, Park BM, Lee KH, Jeon HS (2012) Arthroscopic all-inside repair of medial meniscus root tear using 18 gauge spinal needle and suture anchor—a report of surgical technique. J Korean Arthrosc Soc 16:66–71
Koenig JH, Ranawat AS, Umans HR, Difelice GS (2009) Meniscal root tears: diagnosis and treatment. Arthroscopy 25:1025–1032
Kopf S, Colvin AC, Muriuki M, Zhang X, Harner CD (2011) Meniscal root suturing techniques: implications for root fixation. Am J Sports Med 39:2141–2146
Kurosawa H, Fukubayashi T, Nakajima H (1980) Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci. Clin Orthop Relat Res 149:283–290
LaPrade CM, Foad A, Smith SD, Turnbull TL, Dornan GJ, Engebretsen L, Wijdicks CA, LaPrade RF (2015) Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med 43:912–920
Lee JH, Lim YJ, Kim KB, Kim KH, Song JH (2009) Arthroscopic pullout suture repair of posterior root tear of the medial meniscus: radiographic and clinical results with a 2-year follow-up. Arthroscopy 25:951–958
Lerer DB, Umans HR, Hu MX, Jones MH (2004) The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Skeletal Radiol 33:569–574
Mahfouz M, Abdel Fatah EE, Bowers LS, Scuderi G (2012) Three-dimensional morphology of the knee reveals ethnic differences. Clin Orthop Relat Res 470:172–185
Mastrokalos DS, Papagelopoulos PJ, Mavrogenis AF, Hantes ME, Paessler HH (2008) Changes of the posterior meniscal horn height during loading: an in vivo magnetic resonance imaging study. Orthopedics 31:68
Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, Tandogan RN (2008) Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 16:849–854
Pagnani MJ, Cooper DE, Warren RF (1991) Extrusion of the medial meniscus. Arthroscopy 7:297–300
Papalia R, Vasta S, Franceschi F, D’Adamio S, Maffulli N, Denaro V (2013) Meniscal root tears: from basic science to ultimate surgery. Br Med Bull 106:91–115
Patel VV, Hall K, Ries M, Lotz J, Ozhinsky E, Lindsey C, Lu Y, Majumdar S (2004) A three-dimensional MRI analysis of knee kinematics. J Orthop Res 22:283–292
Pinskerova V, Johal P, Nakagawa S, Sosna A, Williams A, Gedroyc W, Freeman MA (2004) Does the femur roll-back with flexion? J Bone Joint Surg Br 86:925–931
Scarvell JM, Smith PN, Refshauge KM, Galloway H, Woods K (2005) Comparison of kinematics in the healthy and ACL injured knee using MRI. J Biomech 38:255–262
Seo HS, Lee SC, Jung KA (2011) Second-look arthroscopic findings after repairs of posterior root tears of the medial meniscus. Am J Sports Med 39:99–107
Thompson WO, Thaete FL, Fu FH, Dye SF (1991) Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images. Am J Sports Med 19:210–216
Vedi V, Williams A, Tennant SJ, Spouse E, Hunt DM, Gedroyc WM (1999) Meniscal movement. An in vivo study using dynamic MRI. J Bone Joint Surg Br 81:37–41
Walker PS, Erkman MJ (1975) The role of the menisci in force transmission across the knee. Clin Orthop Relat Res 109:184–192
Wang KH, Hwang DH, Cho JH, Changale SD, Woo SJ, Nha KW (2011) Arthroscopic direct repair for a complete radial tear of the posterior root of the medial meniscus. Clin Orthop Surg 3:332–335
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This work was supported by academic promotion research fund of Ajou University School of Medicine (M2015C046000017).
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Chung, J.Y., Song, H.K., Jung, M.K. et al. Larger medial femoral to tibial condylar dimension may trigger posterior root tear of medial meniscus. Knee Surg Sports Traumatol Arthrosc 24, 1448–1454 (2016). https://doi.org/10.1007/s00167-015-3618-4
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DOI: https://doi.org/10.1007/s00167-015-3618-4