The effects of lateral meniscal allograft transplantation techniques on tibio-femoral contact pressures

Abstract

This paper reviews and updates our knowledge of the anatomy and biomechanics of the posterior cruciate ligament, and of the posterolateral, posteromedial and meniscofemoral ligaments of the knee. The posterior cruciate ligament is shown to have two functional fibre bundles that are tight at different angles of knee flexion. It is the primary restraint to tibial posterior draw at all angles of knee flexion apart from near full extension. In contrast, the posterolateral and posteromedial structures are shown to tighten as the knee extends, and to be well-aligned to resist tibial posterior draw. These structures also act as primary restraints against other tibial displacements. Tibial internal rotation is restrained by the medial and posteromedial structures, while tibial external rotation is restrained by the lateral and posterolateral structures. They are also the primary restraints against tibial abduction-adduction rotations. The meniscofemoral ligaments are shown, for the first time, to contribute significantly to resisting tibial posterior draw, and to have a strength of approximately 300 N. Taken together, this evidence shows how the posterolateral and posteromedial structures are responsible for posterior knee stability near extension, and this, along with the action of the meniscofemoral ligaments, may explain why an isolated rupture of the posterior cruciate ligament does not often lead to knee instability

Biomechanics of the meniscus-meniscal ligament construct of the knee

“…It has been found that after en bloc total meniscectomy followed by replacement of the meniscus with both horns attached to a bony block, similar contact areas and peak contact pressures to the intact knee exist. However, replacing the meniscus with just one horn attached or with neither horn attached leads to significant decreases in joint contact areas and increases in peak contact pressures [1,18,50,59,71]. Furthermore, in rabbits, transection of the anterior or posterior insertional ligaments of the meniscus has been shown to lead to osteochondral changes after 6 and 12 weeks, similar to meniscectomy [74].…”

Meniscus Repair and Transplantation: A Comprehensive Update

“…36,75 Following meniscectomy, the tibiofemoral contact area decreases by approximately 50%, while the contact forces increase 2-fold to 3-fold. 2,32,74 Meniscectomy frequently leads to irreparable joint damage, including articular cartilage degeneration, flattening of articular surfaces, and subchondral bone sclerosis. 26,49,66,79 Poor long-term clinical results have been reported by many investigators following partial and total meniscectomy.…”

Arthroscopic Meniscal Allograft Transplantation With Soft-Tissue Fixation Through Bone Tunnels

“…1 Recent studies have failed to show a significant biomechanical or clinical advantage of bone plug fixation over an all-suture technique. 4,5 Meniscal transplants secured by soft-tissue fixation have shown histologic advantages compared with bone plug fixation grafts. Significantly higher cellular viability and collagen organization were found on biopsy of the grafts secured by soft-tissue fixation only, which may be related to a higher immunologic host response caused by the addition of bone plugs.…”