Comparative Biomechanical Study on Contact Alterations After Lateral Meniscus Posterior Root Avulsion, Transosseous Reinsertion, and Total Meniscectomy

• Published in: Arthroscopy Vol. 32; no. 4; pp. 624 - 633
• Main Authors: Perez-Blanca, Ana, M.Eng, Espejo-Baena, Alejandro, M.D, Amat Trujillo, Daniel, M.D., Ph.D, Prado Nóvoa, María, M.Eng., Ph.D, Espejo-Reina, Alejandro, M.D, Quintero López, Clara, M.D, Ezquerro Juanco, Francisco, M.Eng., Ph.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2016
• Subjects: Aged; Aged, 80 and over; Biomechanical Phenomena; Cadaver; Female; Humans; Knee Injuries - physiopathology; Knee Injuries - surgery; Knee Joint - physiopathology; Knee Joint - surgery; Male; Menisci, Tibial - surgery; Middle Aged; Orthopedics; Pressure; Range of Motion, Articular; Replantation - methods; Sutures; Tibial Meniscus Injuries
• ISSN: 0749-8063; 1526-3231
• DOI: 10.1016/j.arthro.2015.08.040

Purpose To compare the effects of lateral meniscus posterior root avulsion left in situ, its repair, and meniscectomy on contact pressure distribution in both tibiofemoral compartments at different flexion angles. Methods Eight cadaveric knees were tested under compressive 1000 N load for 4 lateral meniscus conditions (intact, posterior root avulsion, transosseous root repair, and total meniscectomy) at flexion angles 0°, 30°, 60°, and 90°. Contact area and pressure distribution were registered using K-scan pressure sensors inserted between menisci and tibial plateau. Results In the lateral compartment, root detachment decreased contact area ( P  = .017, 0° and 30°; P  = .012, 60° and 90°) and increased mean ( P  = .012, all angles) and maximum ( P  = .025, 0° and 30°; P  = .017, 60°; P  = .012, 90°) pressures relative to intact condition. Repair restored all measured parameters close to intact at 0°, but effectiveness decreased with flexion angle, yielding no significant effect at 90°. Meniscectomy produced higher decreases than root avulsion in contact area ( P  = .012, 0° and 90°; P  = .05, 30° and 60°) and increases in mean ( P  = .017, 0° and 30°; P  = .018, 90°) and maximum pressure ( P  = .012, 0°; P  = .036, 30°). In the medial compartment, lesion changed the contact area at high flexion angles only, while meniscectomy induced greater changes at all angles. Conclusions Lateral meniscus posterior root avulsion generates significant alterations in contact area and pressures at lateral knee compartment for flexion angles between full extension and 90°. Meniscectomy causes greater disorders than the avulsion left in situ. Transosseous repair with a single suture restores these alterations to conditions close to intact at 0° and 30° but not at 60° and 90°. Clinical Relevance Altered contact mechanics after lateral meniscus posterior root avulsion might have degenerative consequences. Transosseous repair with one suture should be revised to effectively restore contact mechanics at high flexion angles.