Tibiofemoral contact mechanics following posterior root of medial meniscus tear, repair, meniscectomy, and allograft transplantation

Abstract

The purposes of this study were to evaluate the effect on tibiofemoral contact mechanics of repair of the posterior root of the medial meniscus and the effect of meniscal allograft transplantation (MAT) with medial collateral ligament (MCL) release at different flexion angles. Ten fresh-frozen human cadaveric knees (five pairs) were used. A digital pressure sensor was inserted by capsulotomy, and experiments were performed serially under the following six conditions, that is, with an intact medial meniscus (normal controls), with a root tear, after root repair, after total meniscectomy, after MAT, and after MAT plus MCL release. During each experiment, knees were positioned at 0A degrees, 30A degrees, 60A degrees, and 90A degrees of flexion, and peak pressure (kPa) and contact area (cm(2)) were measured. At 0A degrees of flexion, contact pressure did not differ among the six experimental settings. However, at 30A degrees and 60A degrees of flexion, contact pressure differed significantly between root tear and root repair specimens (p = 0.04 and 0.03, respectively), and between total meniscectomy and MAT specimens (p = 0.02 and 0.03, respectively). On the other hand, mean contact pressures were different between normal (476.7 +/- A 473.1 and 573.3 +/- A 479.1 kPa) and root repair (575.7 +/- A 357.8 and 598.6 +/- A 415.8), and between normal and MAT (635.7 +/- A 437.4 and 674.3 +/- A 533.2). At 0A degrees, 30A degrees, 60A degrees, and 90A degrees of flexion, contact areas differed significantly between normal and total meniscectomy specimens (p = 0.02, 0.01, 0.02, and 0.02, respectively), and between MAT and total meniscectomy specimens (p = 0.03, 0.02, 0.02, and 0.03, respectively). Contact areas differed significantly between root tear and root repair specimens at 60A degrees of flexion (p = 0.04), and between normal control and root repair specimens at 60A degrees and 90A degrees of flexion (p = 0.03 and 0.04, respectively). The effects of MAT plus MCL release on contact mechanics were not different from the effects of MAT alone (n.s.). Both meniscal root repair and transplantation of meniscus improved contact mechanics, but it did not appear that repair of the meniscal root or transplantation of meniscus restores the biomechanical function back to normal level. The MAT plus MCL release was similar to those after MAT alone. Therefore, it is better to preserve meniscus and MCL release could be done during the MAT.