The menisci are not shock absorbers: A biomechanical and comparative perspective

Gecelter, Rachel; Ilyaguyeva, Yaffa; Thompson, Nathan E.

doi:10.1002/ar.24752

Cited by 4 publications

(3 citation statements)

References 124 publications

(200 reference statements)

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“…The meniscus has a critical role in stress reduction and load distribution of the knee joint [1][2][3]. Meniscal lesions represent the most common injury of the knee and can severely affect patients' quality of life.…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic surgery or exercise therapy for degenerative meniscal lesions: a systematic review of systematic reviews

et al. 2022

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Background Arthroscopic partial meniscectomy (APM) is widely applied for the treatment of degenerative meniscal lesions in middle-aged patients; however, such injury is often associated with mild or moderate osteoarthritis and has been reported by MRI in asymptomatic knees. Previous studies suggested, in most patients, a lack of benefit of surgical approach over conservative treatment, yet many controversies remain in clinical practice. Our aims were to assess the functional and pain scores between exercise therapy and arthroscopic surgery for degenerative meniscal lesions and to evaluate the methodological quality of the most recent systematic reviews (SRs). Methods Two authors independently searched PubMed and Google Scholar for SRs comparing the outcome (in knee pain and functionality) of arthroscopic treatment and exercise therapy or placebo for degenerative meniscal lesions. The timeframe set was from 2009 to 2019 included. Results A total of 13 SRs were selected. Two reviewers independently assessed the methodological quality of each paper using the AMSTAR 2 tool: seven scored as “moderate,” four obtained a “low” grade while the remaining two were evaluated as “critically low.” SRs agreed that in middle-aged patients with degenerative meniscal lesions arthroscopic surgery appears to grant no long-term improvement in pain and function over exercise therapy or placebo. Conclusions Conservative treatment based on physical therapy should be the first-line management. However, most SRs revealed subgroups of patients that fail to improve after conservative treatment and find relief when undergoing surgery. In the future, randomized controlled trials, evidence should be looked for that APM can be successful in case of the unsatisfactory results after physical therapy.

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Section: Introductionmentioning

confidence: 99%

Arthroscopic surgery or exercise therapy for degenerative meniscal lesions: a systematic review of systematic reviews

et al. 2022

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“…The anterior portion of the medial meniscus contains this ligament. 8 The instability of the torn section of the meniscus causes the symptoms that accompany a meniscal tear induced by trauma. If the "bucket handle" tendon is ruptured, the knee may become immobilized or locked as a result of these symptoms.…”

Section: Introductionmentioning

confidence: 99%

Mechanism of Meniscal Injury and its Impact on Performance in Athletes

Makki¹,

Tahir²,

Amin³

et al. 2022

THJ

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Background: In today’s life style, the gap between athletic activities and daily life activities is becoming wider. The daily life routine is becoming sedentary due to technology and sports activities and thus require high level of physical performance. Knee joint is the most vulnerable to rapid forces and injuries, in which meniscal injury is quite noticeable. Objective: To determine the mechanism of meniscal injury and its impact on performance in athletes after knee meniscal injury. Methods: After taking approval from ethical committee, consent was taken from the athletes prior to filling out the forms. The study was conducted on 145 male athletes in Lahore, aged between 17 to 40 years. Data was collected through international knee documentation committee subjective knee form which consisted of demographical data and questions which were divided into three sections; symptoms, sports activities and knee functions. Results: The main results regarding the mechanism of meniscal injury showed that there were 29% athletes having insidious tear, 16.6% acute noncontact, 32.4% contact with player and 22.1% non-specific mechanism of tear. The mean and standard deviation of total international knee documentation committee score was found to be 66.64±3.83, reflecting a moderately affected level of performance. Conclusion: The findings concluded that the common mechanism of meniscal injury was during contact with player or defense strategy during activity. The athletic performance level due to meniscal injury was moderately affected.

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“…“The shocking truth about meniscus” by Andrews et al (2011) revealed major flaws of the three most cited publications ( Krause et al, 1976 ; Kurosawa et al, 1980 ; Voloshin and Wosk, 1983 ) that affiliate the meniscus with this shock-absorbing ability. Moreover, a recent commentary ( Gecelter et al, 2021 ) came to the conclusion that based both on the mechanical properties and the evolutionary origin, the menisci are not shock absorbers. In contrast, there is evidence assigning a shock-absorbing function directly to the meniscus material itself ( Pereira et al, 2014 ; Gaugler et al, 2015 ; Coluccino et al, 2017 ) and to the knee joint during activities of daily living ( Winter, 1983 ; Ratcliffe and Holt, 1997 ).…”

Section: Introductionmentioning

confidence: 99%

Knee Joint Menisci Are Shock Absorbers: A Biomechanical In-Vitro Study on Porcine Stifle Joints

Seitz

Schwer

Roy

et al. 2022

Front. Bioeng. Biotechnol.

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The aim of this biomechanical in vitro study was to answer the question whether the meniscus acts as a shock absorber in the knee joint or not. The soft tissue of fourteen porcine knee joints was removed, leaving the capsuloligamentous structures intact. The joints were mounted in 45° neutral knee flexion in a previously validated droptower setup. Six joints were exposed to an impact load of 3.54 J, and the resultant loss factor (η) was calculated. Then, the setup was modified to allow sinusoidal loading under dynamic mechanical analysis (DMA) conditions. The remaining eight knee joints were exposed to 10 frequencies ranging from 0.1 to 5 Hz at a static load of 1210 N and a superimposed sinusoidal load of 910 N (2.12 times body weight). Forces (F) and deformation (l) were continuously recorded, and the loss factor (tan δ) was calculated. For both experiments, four meniscus states (intact, medial posterior root avulsion, medial meniscectomy, and total lateral and medial meniscectomy) were investigated. During the droptower experiments, the intact state indicated a loss factor of η = 0.1. Except for the root avulsion state (−15%, p = 0.12), the loss factor decreased (p < 0.046) up to 68% for the total meniscectomy state (p = 0.028) when compared to the intact state. Sinusoidal DMA testing revealed that knees with an intact meniscus had the highest loss factors, ranging from 0.10 to 0.15. Any surgical manipulation lowered the damping ability: Medial meniscectomy resulted in a reduction of 24%, while the resection of both menisci lowered tan δ by 18% compared to the intact state. This biomechanical in vitro study indicates that the shock-absorbing ability of a knee joint is lower when meniscal tissue is resected. In other words, the meniscus contributes to the shock absorption of the knee joint not only during impact loads, but also during sinusoidal loads. The findings may have an impact on the rehabilitation of young, meniscectomized patients who want to return to sports. Consequently, such patients are exposed to critical loads on the articular cartilage, especially when performing sports with recurring impact loads transmitted through the knee joint surfaces.

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The menisci are not shock absorbers: A biomechanical and comparative perspective

Cited by 4 publications

References 124 publications

Arthroscopic surgery or exercise therapy for degenerative meniscal lesions: a systematic review of systematic reviews

Arthroscopic surgery or exercise therapy for degenerative meniscal lesions: a systematic review of systematic reviews

Mechanism of Meniscal Injury and its Impact on Performance in Athletes

Knee Joint Menisci Are Shock Absorbers: A Biomechanical In-Vitro Study on Porcine Stifle Joints

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