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Effect of degenerative and radial tears of the meniscus and resultant meniscectomy on the knee joint: a finite element analysis.

ABSTRACT: Objective:The objective of this study is to investigate the biomechanics on the knee components caused by degenerative and radial meniscal tears and resultant meniscectomy. Methods:A detailed finite element model of the knee joint with bones, cartilages, menisci and main ligaments was constructed from a combination of computed tomography and magnetic resonance images. Degenerative and radial tears of both menisci and resultant medial meniscectomy were used and two different kinds of simulations, the vertical and the anterior load, mimicking the static stance and slight flexion simulations, were applied on the model. The compressive and shear stress and meniscus extrusion were evaluated and compared. Results:Generally, both degenerative and radial tears lead to increased peak compressive and shear stress of both cartilages and menisci and large meniscus extrusion, and the medial meniscal tear induced larger value of stress and extrusion than the lateral meniscal tear. The peak stress and meniscus extrusion further elevated after the medial meniscus meniscectomy. Distribution of stress was shifted from the intact hemi joint to the injured hemi joint with either medial or lateral meniscal tear. Conclusion:Our finite element model provides a realistic three-dimensional knee model to investigate the effects of degenerative and radial meniscal tears and resultant meniscectomy on the stress distribution of the knee. The stress was increased in meniscal tears and increased significantly when meniscectomy was performed. Increased meniscus extrusion may explain the mechanism for higher stress on the components of the knee. The translational potential of this article:Meniscal tears are the most common damage associated to the menisci, and meniscectomy is often performed to relieve the pain and instability of the knee. The results of our study indicated increased stress on cartilages and menisci, which may lead to early onset of osteoarthritis. This may guide surgeons to preserve more of the meniscus when performing meniscectomy.

SUBMITTER: Zhang K

PROVIDER: S-EPMC6718922 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:OBJECTIVES:To assess the long-term effects of arthroscopic partial meniscectomy (APM) on the development of radiographic knee osteoarthritis, and on knee symptoms and function, at 5 years follow-up. DESIGN:Multicentre, randomised, participant- and outcome assessor-blinded, placebo-surgery controlled trial. SETTING:Orthopaedic departments in five public hospitals in Finland. PARTICIPANTS:146 adults, mean age 52 years (range 35-65 years), with knee symptoms consistent with degenerative medial meniscus tear verified by MRI scan and arthroscopically, and no clinical signs of knee osteoarthritis were randomised. INTERVENTIONS:APM or placebo surgery (diagnostic knee arthroscopy). MAIN OUTCOME MEASURES:We used two indices of radiographic knee osteoarthritis (increase in Kellgren and Lawrence grade ?1, and increase in Osteoarthritis Research Society International (OARSI) atlas radiographic joint space narrowing and osteophyte sum score, respectively), and three validated patient-relevant measures of knee symptoms and function (Western Ontario Meniscal Evaluation Tool (WOMET), Lysholm, and knee pain after exercise using a numerical rating scale). RESULTS:There was a consistent, slightly greater risk for progression of radiographic knee osteoarthritis in the APM group as compared with the placebo surgery group (adjusted absolute risk difference in increase in Kellgren-Lawrence grade ?1 of 13%, 95% CI -2% to 28%; adjusted absolute mean difference in OARSI sum score 0.7, 95% CI 0.1 to 1.3). There were no relevant between-group differences in the three patient-reported outcomes: adjusted absolute mean differences (APM vs placebo surgery), -1.7 (95% CI -7.7 to 4.3) in WOMET, -2.1 (95% CI -6.8 to 2.6) in Lysholm knee score, and -0.04 (95% CI -0.81 to 0.72) in knee pain after exercise, respectively. The corresponding adjusted absolute risk difference in the presence of mechanical symptoms was 18% (95% CI 5% to 31%); there were more symptoms reported in the APM group. All other secondary outcomes comparisons were similar. CONCLUSIONS:APM was associated with a slightly increased risk of developing radiographic knee osteoarthritis and no concomitant benefit in patient-relevant outcomes, at 5 years after surgery. TRIAL REGISTRATION:ClinicalTrials.gov (NCT01052233 and NCT00549172).

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Effect of degenerative and radial tears of the meniscus and resultant meniscectomy on the knee joint: a finite element analysis.

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