Abstract
BackgroundThis study evaluated the influence of meniscal allograft transplantation (MAT) on knee joint mechanics during normal walking using finite element (FE) analysis and biomechanical data.MethodsThe study included 20 patients in a transpatellar group and 25 patients in a parapatellar group. Patients underwent magnetic resonance imaging (MRI) evaluation after lateral MAT as a baseline input for three-dimensional (3D) and FE analyses. Three different models were compared for lateral MAT: intact, transpatellar approach, and parapatellar approach. Analysis was performed using high kinematic displacement and rotation inputs based on the kinematics of natural knees. ISO standards were used for axial load and flexion. Maximum contact stress on the grafted menisci and maximum shear stress on the articular surface of the knee joint were evaluated with FE analysis.ResultsRelatively high maximum contact stresses and maximum shear stresses were predicted in the medial meniscus and cartilage of the knee joint during the loading response for all three knee joint models. Maximum contact stress and maximum shear stress in the meniscus and cartilage increased on the lateral side after lateral MAT, especially during the first 20% of the stance phase of the gait cycle. The transpatellar approach was most similar to the intact knee model in terms of contact stresses of the lateral grafted and medial meniscus, as well as maximum shear stresses during the gait cycle. In addition, the transpatellar model had lower maximum contact stress on the menisci than did the parapatellar model, and it also had lower maximum shear stress on the tibial cartilage.ConclusionsTherefore, the transpatellar approach may reduce the overall risk of degenerative osteoarthritis (OA) after lateral MAT.
Highlights
A meniscectomy may lead to early osteoarthritis (OA)
We assumed specific shapes and material properties for the menisci, the purpose of this study is to demonstrate that the transpatellar approach provides more clinically correct positioning 2 years after surgery using 3D in vivo analysis and to evaluate the effect of this correct positioning on OA
Unlike other studies that used finite element (FE) analysis, we used patient data to develop the FE models and ensure realistic simulation. Both maximum contact stress and maximum shear stress were lower in the transpatellar model than in the parapatellar model
Summary
A meniscectomy may lead to early osteoarthritis (OA) Meniscus preserving techniques, such as repairs or partial resections, have become mainstream treatments for meniscus injuries. It is not always possible to insert meniscal allografts in an anatomically correct position when using the parapatellar approach [4, 5]. The transpatellar approach, which allows surgeons to achieve anatomical placement of the meniscal allograft, has recently been introduced to overcome the weaknesses of the parapatellar approach [6]. Some studies have indicated that the parapatellar approach is the best method for achieving correct anatomical positioning [4, 5]; Koh et al Journal of Orthopaedic Surgery and Research (2019) 14:300 there has been no biomechanical study comparing transpatellar and parapatellar approaches. This study evaluated the influence of meniscal allograft transplantation (MAT) on knee joint mechanics during normal walking using finite element (FE) analysis and biomechanical data
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