Abstract
PurposeTo evaluate the functional biomechanical performance of a novel anatomically shaped, polycarbonate urethane total meniscus implant.MethodsFive human cadaveric knees were flexed between 0° and 90° under compressive loads mimicking a squat movement. Anteroposterior (AP) laxity tests were performed in 30° and 90° flexion. Meniscal kinematics and knee laxity were quantified using roentgen stereophotogrammetric analysis. Tibial cartilage contact mechanics were determined in 90° flexion. Measurements were repeated for the native medial meniscus, the implant, after total medial meniscectomy and allograft transplantation.ResultsThe implant and allograft displayed increased posterior and medial displacements compared to the native meniscus, yet no differences were found between the implant and allograft. Meniscal condition did not affect rotational laxity. Compared to the native joint, AP laxity for the implant was increased in 30° flexion, but not in 90°. The implant reduced the mean contact pressure compared to meniscectomy but could not restore contact pressures to native meniscus levels. Compared to the native meniscus, the implant significantly increased the peak pressure, while the contact area was reduced. Contact mechanics of the implant and allograft were never statistically different.ConclusionsBiomechanical performance was similar for the implant and allograft. However, both meniscal replacements could not restore outcomes to native meniscus levels or sufficiently improve outcomes after meniscectomy. This was presumably caused by the mobility allowed by the suture-only horn fixation. The similarity of implant and allograft performance suggests that the novel implant has the biomechanical potential to serve as an alternative to meniscal allograft transplantation.
Highlights
Being involved in 15 % of the knee injuries in an active population, the menisci are amongst the most vulnerable tissues in the knee joint [19]
A significant increase in the posterior translation was observed when replacing the native meniscus with the implant (p < 0.001) or an allograft (p < 0.001)
The most important finding of the present study was that our anatomically shaped PCU total meniscus implant showed a similar biomechanical performance as a meniscal allograft, but was unable to restore the functionality of the native meniscus
Summary
Being involved in 15 % of the knee injuries in an active population, the menisci are amongst the most vulnerable tissues in the knee joint [19]. In the USA, this results in 650,000 meniscus-related surgeries performed annually, most of which encompass (partial) meniscectomy [3]. In the long term, 50 % of the meniscectomized patients develop symptomatic osteoarthritis [12]. Meniscal allograft transplantation is the only treatment option for symptomatic total meniscectomy patients. Allograft transplantation generally relieves pain and improves knee function [11, 18, 23], several studies suggest structural remodelling and shrinkage of the graft tissue, which may compromise its function in the long term [14, 16, 22]. The availability of allografts is restricted by a limited supply and size-matching requirements
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