Direct measurement of hoop strains in the intact and torn human medial meniscus

doi:10.1016/0268-0033(96)00003-4

Clinical Biomechanics

Volume 11, Issue 5, July 1996, Pages 295-300

https://doi.org/10.1016/0268-0033(96)00003-4 Get rights and content

Abstract

Objective. To measure the circumferential or hoop strains generated in the medial meniscus during loading of the knee joint and to examine the effect of longitudinal and radial tears in the meniscus on these strain values.

Design. An in vitro investigation measuring the circumferential strains in the medial menisci of cadaveric human knees as they were loaded in a materials testing machine.

Background. The menisci transmit approximately 50% of the load through the knee, the rest being transmitted by direct contact of the articular cartilage. Damage to the menisci will alter the pattern of load transmission as will meniscectomy. This study examined the changes in the mechanics of the meniscus in situ as a result of simulated tears to assess the effect of its load carrying capacity and the implications of surgery to remove part or all of a damaged meniscus.

Methods. Nineteen human cadaveric knees were tested. Windows were made in the joint capsule and strain gauges inserted into the anterior, middle and posterior sections of the medial meniscus. The knees were then loaded to three times body weight at speeds of 50 and 500 mm/min, with the knee joint at 0 ° and 30 ° of flexion. The tests were repeated following the creation of a longitudinal or a radial tear in the meniscus.

Results. The intact menisci showed significantly less strain in the posterior section compared to the anterior and middle sections (P < 0.003, with strains of 1.54%, 2.86% and 2.65% respectively). With a longitudinal tear this pattern changed with strains decreasing anteriorly and increasing posteriorly. There were also significant differences at different angles of knee joint flexion not seen in the intact meniscus. 50% radial tears reduced the strains anteriorly whilst a complete radial tear completely defunctioned the meniscus.

Conclusions. This study has shown that there are significantly different hoop strains produced in different sections of the medial meniscus under load and the patterns of strain distribution are disturbed by meniscal tears.

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Meniscal Radial Tears: A Classification System Based on Tear Morphology
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Appropriate management of radial meniscal tears is complex, with continued efforts focused on optimizing diagnostic methods for identification to help dictate treatment, especially as surgical indications for repair have expanded, coupled with improvements in surgical techniques and instrumentation. Currently, no standardized classification system for radial meniscal tears exists, limiting the ability to accurately characterize injury patterns and guide surgical decision-making.
Effect of limb alignment correction on medial meniscus extrusion under loading condition in high tibial osteotomy
2023, Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology
This study aimed to investigate the effect of high tibial osteotomy (HTO) on medial meniscus extrusion (MME) and the association between the changes in limb alignment and MME under weight-bearing (WB) conditions after HTO.
We included 17 patients with knee osteoarthritis (OA) who underwent HTO. MME was evaluated using ultrasonography in supine and unipedal standing positions. Knee alignment was evaluated radiographically using WB, whole-leg radiographs with the hip-knee-ankle angle (HKAA), percentage of the mechanical axis (%MA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA). All measurements were performed serially at four time points: preoperative and 3, 6, and 12 months postoperative. Clinical outcomes were assessed by knee injury and osteoarthrosis outcome score (KOOS) and visual analogue scale (VAS) value for pain.
Mean MME in the WB position was significantly greater than that in the supine position in the preoperative condition; however, MME in both supine and WB positions was significantly lowered postoperatively. The ΔMME, difference of MME between supine and WB positions, was significantly lowered postoperatively and maintained for up to 1 year. MME change in the WB position between preop and postoperative conditions was significantly correlated with change in HKAA and %MA at 1 year postoperative. KOOS and VAS score were significantly improved after HTO.
HTO correcting varus alignment can decrease MME in WB position and minimise the change in MME between supine and WB positions. The changes in MME after HTO were correlated with changes in the mechanical alignments.
Relationship between medial meniscus extrusion and damage to medial stabilizers: Should extrusion be considered significant only when more than 3 mm?
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This study was conducted with patients with anterior and medial extrusion of the medial meniscus (MM-AE, MM-ME) to investigate the relationship of the amount of extrusion with damage to the meniscus, meniscofemoral ligament (MFL), meniscotibial ligament (MTL), presence of effusion, osteoarthritis (OA) grade and other medial stablizers. A cut-off value for significant MM-ME was also suggested.
All patients aged 18 and above who had measurable MM extrusion on knee MRI were included. Patients with acute injury detected on knee MRI and any disease that could disrupt the anatomy were not included. The relationship between the amount of MM-AE, MM-ME and the investigated comorbidities were evaluated. The patients were divided into two: those with and without positive findings for each comorbidities. The amount of MM-AE, MM-ME were evaluated. ROC analysis was undertaken for significant differences, and cut-off values were determined.
There was a correlation between MM-ME and age, weight, and BMI (p < 0.001, p = 0.027, p = 0.025, respectively). The amount of MM-ME was higher in the groups with OA (p = 0.007), MTL damage (p < 0.001), MFL damage (p < 0.001), meniscus damage (p < 0.001), effusion (p < 0.001), and the amount of MM-AE was higher in the groups with OA (p = 0.042), effusion (p = 0.002). The cut-off values of MM-ME were determined to be 2.69 mm (MTL), 2.65 mm (MFL), 2.49 mm (meniscus), and 2.85 mm (OA).
OA grade, effusion, and meniscus, MTL, and MFL damage were all found to be related to the amount of MM-ME. MM-ME values 2.49–2.85 mm may indicate meniscus, MFL, MTL damage and OA.
Total Knee Arthroplasty After Meniscectomy Is More Likely in Patients With Bicompartmental or Complex Tears
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To determine the relationship between meniscus tear morphologies, stratified by location and pattern, and knee arthroplasty rates in a commercial insurance population.
The PearlDiver database was queried for patients ≥35 years old with a meniscus tear of specified laterality and ≥2 years follow-up between 2015 and 2018. Two analyses were conducted with cohorts matched on age, sex, Charlson Comorbidity Index, obesity, osteoarthritis (OA), and treatment (meniscectomy vs conservative): one with equal-sized subgroups by tear location (medial only, lateral only, or both medial and lateral) and another by tear pattern (bucket-handle, complex, or peripheral). The rate of subsequent total knee arthroplasty (TKA) was compared between matched groups.
In total, 129,987 patients (mean age: 57.8 ± 10.5 years) were matched by tear location; 1,734 patients with medial-only tears (4.0%), 1,786 with lateral-only tears (4.1%), and 2,611 with medial plus lateral tears (6.0%) underwent a TKA within 5 years (P < .001). Patients with both medial and lateral tears were 1.55-fold more likely to undergo TKA. In total, 24,213 patients (mean age: 56.0 ± 10.5 years) were matched by tear pattern; 296 patients with bucket-handle tears (3.7%), 373 with complex tears (4.6%), and 336 with peripheral tears (4.2%) underwent TKA (P = .01). Patients with complex tears were 1.29-fold more likely to undergo TKA than patients with bucket-handle tears (P = .002).
In matched cohorts of patients with degenerative meniscus tears, having both medial plus lateral tears conferred a 1.5-fold risk of TKA, whereas complex tears conferred a 1.3-fold risk within 5 years. Specific meniscal tear patterns and locations harbor varying risk in progressing to end-stage knee OA, and these data may help counsel patients about their likelihood of progressing to end-stage OA warranting an arthroplasty procedure.
Level III, retrospective comparative study.
Regeneration Using Adipose-Derived Stem Cell Sheets in a Rabbit Meniscal Defect Model Improves Tensile Strength and Load Distribution Function of the Meniscus at 12 Weeks
2023, Arthroscopy - Journal of Arthroscopic and Related Surgery
The purpose of this study was to evaluate the mechanical properties, such as the tensile strength and load distribution function, of the meniscus tissue regenerated using adipose-derived stem cell (ADSC) sheets in a rabbit meniscal defect model.
ADSC sheets were prepared from adipose tissue of rabbits. The anterior half of the medial meniscus was removed from both knees. One knee was transplanted with an ADSC sheet; the contralateral knee was closed without transplantation. Mechanical tests were performed at 4 and 12 weeks posttransplantation. In the tensile test, tensile force was applied to the entire medial meniscus, including the normal area (n = 10/group). Compression tests were performed on the entire knee, with soft tissues other than the ligament removed. A pressure-sensitive film was inserted under the medial meniscus and a 40-N load was applied (n = 5/group).
In the tensile test, the elastic modulus in ADSC-treated knees was higher at 12 weeks (ADSC: 70.30 ± 18.50 MPa, control: 43.71 ± 7.11 MPa, P = .009). The ultimate tensile strength (UTS) in ADSC-treated knees at 12 weeks was also higher (ADSC: 22.69 ± 5.87 N, control: 15.45 ± 4.08 N, P = .038). In the compression test, the contact area was larger in the ADSC group at 4 weeks (ADSC: 31.60 ± 8.17 mm², control: 20.33 ± 2.86 mm², P = .024) and 12 weeks (ADSC: 41.07 ± 6.09 mm², control: 30.53 ± 5.47 mm², P = .04). Peak pressure was significantly lower in ADSC-treated knees at 12 weeks (ADSC: 11.91 ± 1.03 MPa, control: 15.53 ± 2.3 MPa, P = .002).
The regenerated meniscus tissue, 12 weeks after transplantation of the ADSC sheets into the meniscal defect area, had high elastic modulus and UTS. In the meniscus-tibia compartment, the contact area was large and the peak pressure was low.
ADSC sheets promoted regeneration of meniscus. ADSC sheet transplantation for meniscal defects could be an effective regenerative therapy.
Knee adduction moment is correlated with the increase in medial meniscus extrusion by dynamic ultrasound in knee osteoarthritis
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Citation Excerpt :
However, the meniscus commonly degenerates and tears and is associated with medial meniscus extrusion (MME) [3–5]. MME gradually increases over time, and a greater MME catalyses the progression of knee OA due to meniscus dysfunction [6,7]. Therefore, understanding the mechanism underlying an increasing MME is essential for preventing the progression of knee OA.
An increase in medial meniscus extrusion (MME) due to abnormal biomechanical stress leads to knee osteoarthritis (OA) progression. MME evaluation during walking is a key method of detecting dynamic changes in the meniscus, and in combination with motion analysis, can provide a deeper understanding of the mechanisms involved in the increase of MME.
To validate the feasibility of MME dynamic evaluation in combination with a motion analysis system based on the correlation between the increase in MME and biomechanical factors.
Twenty-three knees from 23 patients with mild to moderate knee OA were analysed in this study. The medial meniscus during walking was evaluated by ultrasound. The increase in MME was calculated as the difference between the minimum and maximum MME during walking. A three-dimensional motion analysis system was synchronised with the ultrasound and then, biomechanical factors such as knee moment and ground reaction force were evaluated.
The wave patterns of the mediolateral and vertical components of ground reaction forces and knee adduction moment were similar to those in the MME based on a high cross-correlation coefficient (>0.8). The increase in MME was significantly correlated with the peak value of the knee adduction moment (r = 0.54, P = 0.0073) but not with the mediolateral and vertical components of the ground reaction force.
The findings show that knee adduction moment is correlated with an increase in MME during walking and indicates the validity and feasibility of the dynamic evaluation of MME in combination with a motion analysis system.

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Direct measurement of hoop strains in the intact and torn human medial meniscus

Abstract

J Biomed Eng

Arthroscopy

Mechanical changes in the knee after meniscectomy

J Bone Joint Surg

The effect of medial meniscectomy on anterior-posterior motion of the knee

J Bone Joint Surg

Stiffness and laxity of the knee — the contributions of the supporting structures

J Bone Joint Surg

Collagen orientations in the meniscus of the knee joint

J Anat

Knee menisci-correlation between microstructure and biomechics

Clin Orthop

The strength of the menisci of the knee as it relates to their fine structure

J Bone Joint Surg

Knee joint changes after meniscectomy

J Bone Joint Surg

Transmission of the load in the knee joint with special reference to the role of the menisci

Eng Med

Material properties and structure-function relationships in the menisci

Clin Orthop

Functions of the menisci — a preliminary study

The weight-bearing role of the menisci of the knee

In vitro measurement of static pressure distribution in synovial joints. Part 1: Tibial surface of the knee

J Biomech Eng

Load-bearing mode of the knee joint: physical behaviour of the knee joint with or without menisci

Clin Orthop

The effect of medial meniscectomy and coronal plane angulation on in vitro load transmission in the canine stifle joint

J Orthop Res