Tibiofemoral contact mechanics following a horizontal cleavage lesion in the posterior horn of the medial meniscus

Abstract

The purpose of this study was to determine if a horizontal cleavage lesion (HCL) of the posterior horn of the medial meniscus would result in changes to tibiofemoral contact mechanics, as measured by peak contact pressure and contact area, which can lead to cartilage degeneration. To study this, 10 cadaveric knees were tested in a rig where forces were applied (500 N Compression, 100 N shear, 2.5 Nm Torque) and the knee dynamically flexed from À5˚to 135˚, as peak contact pressure and contact area were recorded. After testing of the intact knee, a horizontal cleavage lesion was created arthroscopically and testing repeated. The Wilcoxon signed-rank test was used to determine if there were differences in peak contact pressure and contact area between the intact knee and that with the HCL. A statistically significant increase in peak contact pressure of 13%, on average, and a decrease in contact area of 6%, on average, was noted following the HCL. This suggests that a horizontal cleavage lesion will result in small but statistically significant changes in tibiofemoral contact mechanics which may lead to cartilage degeneration. Keywords: horizontal cleavage lesion; peak contact pressure; contact area; osteoarthritis; MRI The medial meniscus has been shown to aid in load distribution, bearing 60% of the load in the knee. [1][2][3] Several studies have shown that following a traumatic tear, such as a radial tear or posterior root tear, a decrease in contact area and an increase in peak contact pressure on the tibial cartilage can occur compared to the intact knee. [4][5][6][7] Similar to the changes in tibiofemoral contact mechanics following partial meniscectomy, these loading changes are believed to lead to the Fairbank changes that characterize osteoarthritis (OA). 8,9 However, it is not clear if degenerative tears also have such an effect on load distribution and thus contact mechanics. One type of degenerative tear is the horizontal cleavage lesion (HCL), which is a horizontal tear of the meniscus, predominantly occurring in the region of the posterior horn, separating the meniscus into a top and bottom flap. 10,11 It is believed to occur as a result of fatigue from shear forces on the meniscus, and therefore occurs predominantly in older patients. 10,12 Although originally believed to be benign and asymptomatic, the horizontal cleavage lesion has been shown to be associated with an increased incidence of osteoarthritis. 11,13 However, it is not clear if the HCL has a causal role in this relationship, resulting in changes in tibiofemoral contact mechanics which can lead to cartilage degeneration. Therefore, in this study, we sought to determine if an HCL of the posterior horn of the medial meniscus would result in changes in tibiofemoral contact mechanics, as measured by peak contact pressure and contact area, which can lead to cartilage degeneration.We hypothesized that an HCL of the posterior horn of the medial meniscus would result in an increase in peak contact pressure and a decrease in contact are...

Arthroscopic Meniscectomy for Medial Meniscus Horizontal Cleavage Tears in Patients under Age 45

“…Terzidis et al7) reviewed 378 isolated meniscal tears in young athletes and found that 22.5% of the tears were HCTs. As HCTs can result in changes in the tibiofemoral contact mechanics that may lead to cartilage degeneration8), it is mandatory to know the characteristics and natural courses of HCTs in younger patients. Causes, clinical features, and natural courses of HCTs in younger patients may differ from those in the middle-aged and elderly patients.…”

Effects of focal metallic implants on opposing cartilage – an in-vitro study with an abrasion test machine

“…3 Macroscopic picture of a specimen stained with ink according to Meachim [31] after tested for 6 h in hyaluronic acid. Left picture 0°p erspective; right picture 90°perspective changes in peak contact pressure and contact area between articulating cartilage [1,2,25]. Becher et al [6] evaluated the effect of various FMI positions on contact pressure in the setting of a complete radial tear of the medial meniscus and found significant increases of peak contact pressure even with flush implant positioning.…”

Patterns and Influencing Factors of Medial Meniscus Tears in Varus Knee Osteoarthritis

“…Nha et al 13) identified MM root tears in 32.5% of their patients and the prevalence was higher in the MM than in the lateral meniscus, which they attributed to the lesser mobility of the tibial attachment of the posterior horn of the MM than that of the lateral meniscus. On the other hand, Arno et al 14) suggested that changes in the tibiofemoral contact mechanics could result in articular cartilage degeneration in knees with horizontal cleavage lesions unaccompanied by loss of hoop tension.…”