Abstract
BackgroundPatients undergoing total or partial arthroscopic meniscectomy for treating traumatic meniscal tears are at greater risk of developing knee osteoarthritis (OA) due to increased mechanical load. The purpose of this study was to evaluate the effects of a valgus unloader brace in the medial meniscectomized knee joint during the gait cycle.MethodsA three-dimensional finite element model of the knee joint was developed using the substructures segmented from magnetic resonance images. Experimentally measured forces and moments for one complete gait cycle, without brace and with brace at three different alignment angles (0°, 4°, and 8°), were applied to the finite element model, and the changes in the tibiofemoral contact mechanics were estimated.ResultsThe brace in 0°/4°/8° valgus alignment modes reduced the total contact force in the medial compartment by 16%/46%/82% at opposite toe off and 18%/17%/29% at opposite initial contact events, while it increased the total contact force in the lateral compartment by 31%/81%/110% at opposite toe off and 30%/38%/45% at opposite initial contact events, respectively, when compared to the unbraced meniscectomized knee.ConclusionsIncreasing the valgus alignment from 0° to 4° and 8° resulted in a greater reduction of contact conditions (total contact force, total contact area, peak contact pressure) in the medial compartment and vice versa in the lateral compartment. This decrease in contact conditions in the medial compartment infers enhanced knee joint function due to a valgus unloader brace, which translates to increased knee-related confidence. Results suggest choosing a higher valgus alignment angle could potentially increase the risk for the onset of osteoarthritis in the lateral compartment, and this computational model could be used in validating the effectiveness of braces on joint health.
Highlights
Traumatic meniscal injuries are common in young athletes, especially those who are associated with contact sports that entail frequent pivoting [1]
Contact mechanics in the medial compartment Two peak total contact forces were observed in the medial compartment for the unbraced mode at the opposite toe off (OTO) and the opposite initial contact (OIC) events of the gait cycle (Fig. 3a)
The 0°, 4°, and 8° brace alignment modes all demonstrated a significant decrease in total contact area induced on the medial tibial cartilage during the main events of the gait cycle when compared to the unbraced knee (Fig. 3b)
Summary
Traumatic meniscal injuries are common in young athletes, especially those who are associated with contact sports that entail frequent pivoting [1]. Typical surgical procedure to treat the meniscal injury is arthroscopic meniscectomy. Arthroscopic total or partial meniscectomy is one of the primary risk factors for new onset and/or progression of knee osteoarthritis (OA) [2]. Knee joints of patients who have undergone total or partial medial meniscectomy experience higher mechanical loads in the medial compartment when compared to the healthy contralateral ones due to increased knee adduction moment [6]. Patients undergoing total or partial arthroscopic meniscectomy for treating traumatic meniscal tears are at greater risk of developing knee osteoarthritis (OA) due to increased mechanical load. The purpose of this study was to evaluate the effects of a valgus unloader brace in the medial meniscectomized knee joint during the gait cycle
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