Abstract
Loss of meniscal function due to symptomatic meniscal tears or meniscectomy leads to biomechanical instability and articular cartilage degeneration. Synthetic meniscal implants ought to ideally restore normal joint contact mechanics and thus forfending the overlying cartilage from degeneration. The purpose of this study was to quantify the contact stresses in both tibiofemoral compartments and joint kinematics during a gait cycle after implantation of a synthetic meniscal implant. Anatomically-detailed finite element model of the knee joint was developed from magnetic resonance images of a healthy female volunteer. Gait analysis was conducted using a three-dimensional motion capture system and computed the knee joint forces and moments and quadriceps muscle forces for a complete walking cycle. The effects of a synthetic meniscal implant on joint mechanics during gait were studied by conducting finite element simulations for the following meniscus conditions: (i) intact meniscus, (ii) meniscus with complete radial posterior root tear, (iii) total meniscectomy, (iv) isotropic meniscal implant, and (v) shell-core composite meniscal implant. Posterior root tear and total meniscectomy caused substantially increased contact stresses in both tibiofemoral compartments and altered tibial kinematics. Compared to posterior root tear and total meniscectomy, the isotropic and composite meniscal implants reduced the peak contact stresses in both compartments and reduced the cartilage nodes with higher contact stresses by disseminating the load over a large surface area. The shell-core composite meniscal implant resulted in lower contact stresses in the medial compartment relative to the other meniscus conditions. This study demonstrated that posterior root tear and total meniscectomy leads to detrimental changes in joint mechanics. Superseding the injured meniscus with a synthetic meniscal implant restored the joint mechanics close to the intact meniscal state. This novel synthetic meniscal implantation approach appears to be a promising strategy for treating patients with severe meniscal injuries.
Highlights
Meniscal injury and subsequent surgical resection of the meniscus is considered one of the risk factors for theThe associate editor coordinating the review of this manuscript and approving it for publication was Zhonglai Wang.onset of osteoarthritis (OA) [1], apparently because of changes in cartilage contact mechanics [2]
Intact meniscus distributed the contact stresses over a large surface area, posterior root tear and total medial meniscectomy reduced the contact surface area and increased the number of nodes in the anterior-tibial region of the medial tibial plateau with higher contact stresses (Figs. 4B, 4D, 4F)
Some of the significant observations from the current study were that (1) the isotropic and composite meniscal implants restored the normal joint kinematics and contact conditions in both tibiofemoral compartments, (2) the knee joint model with isotropic meniscal implant resulted in a maximum reduction of contact stresses in the lateral compartment and produced the best fit with the normal tibial translational kinematics, and (3) the knee joint model with composite meniscal implant resulted in a maximum reduction of contact stresses in the medial compartment and produced the best fit with the normal tibial rotational kinematics
Summary
Meniscal injury and subsequent surgical resection of the meniscus is considered one of the risk factors for theThe associate editor coordinating the review of this manuscript and approving it for publication was Zhonglai Wang.onset of osteoarthritis (OA) [1], apparently because of changes in cartilage contact mechanics [2]. D. Shriram et al.: Biomechanical Evaluation of Isotropic and Shell-Core Composite Meniscal Implants improves pain and mechanical function of the knee in patients with either partial or total meniscectomy [3], their biophysical chondroprotection of articular cartilage has not yet been demonstrated [4], [5]. The use of meniscal allograft is constrained due to problems with the risk of developing an infection, allograft size matching and fixation, as well as allograft resorption and the likelihood of allograft rupture after transplantation [4]. The use of meniscal allograft is primarily limited to younger patients (
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