Meniscal tears: The effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee

Abstract

The role of the meniscus in load transmission across the knee has long been a subject of debate. In this study, we examined the biomechanical consequences of the operative treatments for bucket-handle and peripheral meniscal tears. Contact areas and instantaneous intraarticular pressure distributions were measured in two groups of human cadaver knees. In Group I, consisting of four knees, we created a bucket-handle tear involving the inner one-third of the meniscus, followed by partial, and then total meniscectomy. Knees were tested in an Instron testing machine after each procedure, using a 400 pound load at 0 degrees or 30 degrees flexion. Contact areas and local stresses were measured using Prescale, a pressure-sensitive film. After partial meniscectomy, contact areas decreased approximately 10%, and peak local contact stresses (PLCS) increased approximately 65%. After total meniscectomy, contact areas decreased approximately 75%, and PLCS increased approximately 235%. In Group II, consisting of three additional knees, we created a 2 cm peripheral tear of the posterior meniscal horn, followed by open repair, arthroscopic repair, segmental, and then total meniscectomy. Repair of the tear was accomplished with either vertically placed sutures by an open technique or horizontally placed sutures by an arthroscopic technique. Knees were tested in the neutral position in the Instron machine and contact areas and local stresses measured using Prescale. PLCSs and contact areas were found to be the same using either repair technique. There was, however, a 110% increase in PLCS after segmental meniscectomy of that portion of the meniscus involved in the peripheral tear.(ABSTRACT TRUNCATED AT 250 WORDS)

Dynamic Contact Mechanics of the Medial Meniscus as a Function of Radial Tear, Repair, and Partial Meniscectomy

“…For this reason, partial meniscectomy has historically been the mainstay of surgical treatment for normal meniscal tears. Despite the benefits of short-term pain relief, partial meniscectomy has been associated with a substantially increased incidence of progressive degenerative changes [18][19][20][21][22][23][24][25][26][27] . This finding has emphasized the importance of meniscal preservation whenever feasible.…”

“…Indeed, degenerative changes associated with meniscectomies have been linked to increased joint contact stress (hereafter referred to as contact pressure) in the adjacent articular cartilage as measured in vitro [18][19][20][21][22][23][24][25][26][27] . To date, however, experimental models have been primarily conducted under static or quasi-static uniaxial loading conditions 8,[28][29][30][31][32][33] .…”

The discoid meniscus

“…Better understanding and documentation of the importance of the menisci to normal articular function has led to preservation of stable meniscal tissue as part of treatment planning. Partial meniscectomy of normal shaped menisci, was shown to increase the contact stresses in proportion to the amount of removed meniscus [49]. Following total meniscectomy, the contact area was decreased by 75% while contact stresses increased by 235% [49].…”

Platelet-rich Plasma in Meniscal Repair: Does Augmentation Improve Surgical Outcomes?

“…One treatment option for the injured meniscus is partial or total meniscectomy, although well-established data suggest that increased contact stresses occurring long term can lead to poor outcomes in many cases [2,3,11,[23][24][25]. Such findings have led to a renewed focus on meniscal preservation strategies to prevent articular cartilage degeneration.…”