Review of Meniscus Anatomy and Biomechanics

Mameri, Enzo S.; Dasari, Suhas P.; Fortier, Luc M.; Verdejo, Fernando Gómez; Gürsoy, Safa; Yanke, Adam B.; Chahla, Jorge

doi:10.1007/s12178-022-09768-1

Cited by 39 publications

(35 citation statements)

References 90 publications

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“…Next, arteries to the menisci pass through the JC (Mameri et al 2022), but in the present study, in addition to this route, arterial access from the peri‐meniscal fat pad to the M‐shaped valley of tie fibres also was observed. That is, there were two route of arterial access into the meniscus: an intracapsular route (the synovial layer and the fibrous layer of the JC to between the superficial layer and lamellar layer) and an intercapsular route (the peri‐meniscal fat pad to the M‐shaped valley of tie fibre).We propose to call the entrance of the two routes the meniscus hilum, since this route connected the inside and outside of the meniscus.…”

Section: Discussionmentioning

confidence: 49%

The continuous structure of the joint capsule and meniscus in the pig knee

Natsuyama

Zhang

Yang

et al. 2023

Anat Histol Embryol

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The knee joint capsules composed of a fibrous layer and a synovial layer. The knee meniscus consists of the superficial network, lamellar layer, tie fibre and circumferential bundles. However, the continuous structure of the knee joint capsule and meniscus has not been reported. Fetal and adult pigs were used to investigate the structural relationship between the stifle joint capsule and meniscus based on the gross anatomy and histological findings. In the gross anatomical examination, the joint capsule appeared to have separated attachments to the meniscus, except for the lower aspect of the popliteal hiatus. Histologically, the lower half of the popliteal hiatus was found to have separated attachments, with vessels running between the attachments of the joint capsules. The synovial layer of the joint capsule continued to the superficial network, and the fibrous layer of the joint capsule continued to the lamellar layer and tie fibres. There were two routes of arterial entry into the meniscus: intracapsular and intercapsular. It appeared that the presence of separated attachments of the joint capsule was necessary to allow the intercapsular route. This study clarified for the first time the routes of feeding vessels entering the meniscus and proposed to call this entry point the meniscus hilum. We consider that this detailed anatomical information is important for understanding the continuation between the joint capsule and the meniscus.

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Section: Discussionmentioning

confidence: 49%

The continuous structure of the joint capsule and meniscus in the pig knee

Natsuyama

Zhang

Yang

et al. 2023

Anat Histol Embryol

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“…[23][24][25] However, in native menisci, an intact collagen network plays a critical role in maintaining meniscal mechanics and subsequent load transmission during joint motion. 17 The application of collagenase was able to remove biophysical barriers and enhance cell migration to the tear interface, while the integrity of the collagen content and network was destroyed irreversibly, which may disrupt the mechanical property of the native meniscus. In terms of organic matrix components, proteoglycans are the main elements, only secondary to collagen.…”

Section: Discussionmentioning

confidence: 99%

Meniscal Fibrocartilage Repair Based on Developmental Characteristics: A Proof-of-Concept Study

Yan,

Zhu,

et al. 2023

Am J Sports Med

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Background: Unlike the adult meniscus, the fetal meniscus possesses robust healing capacity. The dense and stiff matrix of the adult meniscus provides a biophysical barrier for cell migration, which is not present in the fetal meniscus. Inspired by developmental characteristics, modifying the matrix of the adult meniscus into a fetal-like, loose and soft microenvironment holds opportunity to facilitate repair, especially in the avascular zone. Hypothesis: Modifying the dense and stiff matrix of the adult meniscus into a fetal-like, loose and soft microenvironment could enhance cell migration to the tear interface and subsequent robust healing capacity. Study Design: Controlled laboratory study. Methods: Fresh porcine menisci were treated with hyaluronidase or collagenase. The density and arrangement of collagen fibers were assessed. The degradation of proteoglycans and collagen was evaluated histologically. Cell migration within the meniscus or the infiltration of exogenous cells into the meniscus was examined. Dendritic silica nanoparticles with relatively large pores were used to encapsulate hyaluronidase for rapid release. Mesoporous silica nanoparticles with relatively small pores were used to encapsulate transforming growth factor–beta 3 (TGF-β3) for slow release. A total of 24 mature male rabbits were included. A longitudinal vertical tear (0.5 cm in length) was prepared in the avascular zone of the medial meniscus. The tear was repaired with suture, repaired with suture in addition to blank silica nanoparticles, or repaired with suture in addition to silica nanoparticles releasing hyaluronidase and TGF-β3. Animals were sacrificed at 12 months postoperatively. Meniscal repair was evaluated macroscopically and histologically. Results: The gaps between collagen bundles increased after hyaluronidase treatment, while collagenase treatment resulted in collagen disruption. Proteoglycans degraded after hyaluronidase treatment in a dose-dependent manner, but collagen integrity was maintained. Hyaluronidase treatment enhanced the migration and infiltration of cells within meniscal tissue. Last, the application of fibrin gel and the delivery system of silica nanoparticles encapsulating hyaluronidase and TGF-β3 enhanced meniscal repair responses in an orthotopic longitudinal vertical tear model. Conclusion: The gradient release of hyaluronidase and TGF-β3 removed biophysical barriers for cell migration, creating a fetal-like, loose and soft microenvironment, and enhanced the fibrochondrogenic phenotype of reparative cells, facilitating the synthesis of matrix and tissue integration. Clinical Relevance: Modifying the adult matrix into a fetal-like, loose and soft microenvironment via the local gradient release of hyaluronidase and TGF-β3 enhanced the healing capacity of the meniscus.

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“…11 While patients largely experience short-term symptomatic relief following a meniscectomy, 4 an overwhelming number of studies ultimately demonstrated the deleterious longterm effects of this approach, ultimately leading to an increased risk of knee osteoarthritis (OA). 2,5,6,8,11 The biological healing potential in the more central areas of the menisci has been found to be higher than previously thought, as multipotent mesenchymal stromal progenitor cells and microvasculature were recently demonstrated in the white-white zone. 3 Brazilian Society of Knee Surgery Special Issue Sociedade Brasileira de Cirurgia do Joelho Special Issue with modern developments in surgical technique has paved the way for the current emphasis on repairing even radial tears.…”

Section: Video Transcriptmentioning

confidence: 95%

Section: Video Transcriptmentioning

confidence: 99%

Hybrid Repair of a Medial Meniscus Mid-Body Radial Tear

Franciozi,

Mameri,

Schumacher

et al. 2023

Video Journal of Sports Medicine

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Background: Meniscal radial tears are associated with altered contact mechanics, as they have the potential to disrupt the meniscal hoop stress mechanism. In prior studies, radial tears are associated with higher grade of cartilage damage, as well as higher rate and severity of meniscal extrusion in knees with a radial tear relative to other types of tears. Improved understanding of the meniscus biological potential together with modern developments in surgical technique has paved the way for the current emphasis on repairing even radial tears. Indication: Large or complete radial tears of the meniscus without prohibitive joint space narrowing or severe cartilage damage. Technique Description: A hybrid technique of meniscal radial repair is described, combining (1) 2 transtibial pullout cinch-loop sutures, (2) 2 inside-out vertical rip-stop sutures and 2 oblique sutures in a “cross-tag” configuration, and (3) 1 horizontal mattress all-inside suture. The repair is biologically augmented with a notch marrow-venting procedure. Results: Recent evidence has demonstrated significant biomechanical benefit in terms of increased load to failure and construct strength when adding transtibial tunnel augmentation to radial repairs. In addition, rip-stop sutures decrease the chance of cut-out relative to nonreinforced repairs. Those biomechanical advancements are reflected in excellent patient-reported outcomes as well as healing rates following radial repair. Discussion/Conclusion: We present a hybrid technique encompassing the most biomechanically effective novel radial repair techniques, backed by excellent clinical outcomes following radial repair in the current literature. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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Review of Meniscus Anatomy and Biomechanics

Cited by 39 publications

References 90 publications

The continuous structure of the joint capsule and meniscus in the pig knee

The continuous structure of the joint capsule and meniscus in the pig knee

Meniscal Fibrocartilage Repair Based on Developmental Characteristics: A Proof-of-Concept Study

Hybrid Repair of a Medial Meniscus Mid-Body Radial Tear

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