The effect of unloader knee braces on medial meniscal strain

Kalra, Mayank; Bakker, Ryan; Tomescu, Sebastian; Polak, Anna M; Nicholls, Micah; Chandrashekar, Naveen

doi:10.1177/0309364618798173

Cited by 6 publications

(3 citation statements)

References 38 publications

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“…However, during pilot testing, we investigated the potential of applying the method presented here to the posterior meniscus roots. Although other studies have demonstrated the applicability of sensors at the posterior periphery of menisci, 18,19,45 we were unable to attach the displacement sensors without interference of the surrounding soft tissues. Sta ¨rke et al [46][47][48] used a different method, which allowed a direct force measurement at the posterior meniscus roots.…”

Section: Forces Acting On the Anterior Meniscus Attachmentsmentioning

confidence: 81%

Forces at the Anterior Meniscus Attachments Strongly Increase Under Dynamic Knee Joint Loading

et al. 2021

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Background: The anatomic appearance and biomechanical and clinical importance of the anterior meniscus roots are well described. However, little is known about the loads that act on these attachment structures under physiological joint loads and movements. Hypotheses: As compared with uniaxial loading conditions under static knee flexion angles or at very low flexion-extension speeds, more realistic continuous movement simulations in combination with physiological muscle force simulations lead to significantly higher anterior meniscus attachment forces. This increase is even more pronounced in combination with a longitudinal meniscal tear or after total medial meniscectomy. Study Design: Controlled laboratory study. Methods: A validated Oxford Rig–like knee simulator was used to perform a slow squat, a fast squat, and jump landing maneuvers on 9 cadaveric human knee joints, with and without muscle force simulation. The strains in the anterior medial and lateral meniscal periphery and the respective attachments were determined in 3 states: intact meniscus, medial longitudinal tear, and total medial meniscectomy. To determine the attachment forces, a subsequent in situ tensile test was performed. Results: Muscle force simulation resulted in a significant strain increase at the anterior meniscus attachments of up to 308% ( P < .038) and the anterior meniscal periphery of up to 276%. This corresponded to significantly increased forces ( P < .038) acting in the anteromedial attachment with a maximum force of 140 N, as determined during the jump landing simulation. Meniscus attachment strains and forces were significantly influenced ( P = .008) by the longitudinal tear and meniscectomy during the drop jump simulation. Conclusion: Medial and lateral anterior meniscus attachment strains and forces were significantly increased with physiological muscle force simulation, corroborating our hypothesis. Therefore, in vitro tests applying uniaxial loads combined with static knee flexion angles or very low flexion-extension speeds appear to underestimate meniscus attachment forces. Clinical Relevance: The data of the present study might help to optimize the anchoring of meniscal allografts and artificial meniscal substitutes to the tibial plateau. Furthermore, this is the first in vitro study to indicate reasonable minimum stability requirements regarding the reattachment of torn anterior meniscus roots.

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Section: Forces Acting On the Anterior Meniscus Attachmentsmentioning

confidence: 81%

Forces at the Anterior Meniscus Attachments Strongly Increase Under Dynamic Knee Joint Loading

et al. 2021

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“…Prophylactic bracing has demonstrated reduced strain on the posterior horn of the medial meniscus in cadaveric models and has been studied in several populations with widely variable results. 91 In vivo, a medial unloader brace has demonstrated increased peak knee flexion moment and increased knee stability when performing single-leg squat, forward lunge and during ambulation. 30 In collegiate football players, prophylactic bracing compared with no brace significantly reduced medial collateral ligament (MCL) and meniscus injuries.…”

Section: Bracingmentioning

confidence: 99%

“…With overall low quality studies and widely variable data, it is unclear whether bracing can prevent meniscus injury in athletes or occupational groups with high risk physical demands. Prophylactic bracing has demonstrated reduced strain on the posterior horn of the medial meniscus in cadaveric models and has been studied in several populations with widely variable results 91. In vivo, a medial unloader brace has demonstrated increased peak knee flexion moment and increased knee stability when performing single-leg squat, forward lunge and during ambulation 30.…”

Section: Preventionmentioning

confidence: 99%

The Epidemiology of Meniscus Injury

Adams

Houston

Cameron

2021

Sports Medicine and Arthroscopy Review

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Meniscus surgery is one of the most commonly performed orthopedic procedures worldwide. Modifiable risk factors for meniscus injury include body mass index, participation in athletics and occupation. Nonmodifiable risk factors include age, sex, lower extremity alignment, discoid meniscus, ligamentous laxity, and biconcave tibial plateau. Conditions commonly associated with meniscal injury are osteoarthritis, anterior cruciate ligament injury, and tibial plateau fractures. Tear type and location vary by patient age and functional status. Surgical management of meniscus injury is typically cost-effective in terms of quality-adjusted life years. The purpose of this review is to provide an overview of meniscal injury epidemiology by summarizing tear types and locations, associated conditions, and factors that increase the risk for meniscal injury. The economic burden of meniscus injury and strategies to prevent injury to the meniscus are also reviewed.

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Meniscal Root Repair

Alaia

Klein

2020

The Management of Meniscal Pathology

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The effect of unloader knee braces on medial meniscal strain

Cited by 6 publications

References 38 publications

Forces at the Anterior Meniscus Attachments Strongly Increase Under Dynamic Knee Joint Loading

Forces at the Anterior Meniscus Attachments Strongly Increase Under Dynamic Knee Joint Loading

The Epidemiology of Meniscus Injury

Meniscal Root Repair

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